Provider Demographics
NPI:1457445967
Name:FALLAHAY, MICHAEL J (MS,LSW,LMHC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:FALLAHAY
Suffix:
Gender:M
Credentials:MS,LSW,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 NORTH ALABAMA STREET
Mailing Address - Street 2:SUITE 320
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204
Mailing Address - Country:US
Mailing Address - Phone:317-634-6341
Mailing Address - Fax:317-464-9575
Practice Address - Street 1:615 NORTH ALABAMA STREET
Practice Address - Street 2:SUITE 320
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204
Practice Address - Country:US
Practice Address - Phone:317-634-6341
Practice Address - Fax:317-464-9575
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000564A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health