Provider Demographics
NPI:1508080326
Name:TAVEL, SUE C (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:C
Last Name:TAVEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6222 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1927
Mailing Address - Country:US
Mailing Address - Phone:317-252-5683
Mailing Address - Fax:317-858-8401
Practice Address - Street 1:6222 N COLLEGE AVENUE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1927
Practice Address - Country:US
Practice Address - Phone:317-252-5683
Practice Address - Fax:317-858-8401
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002086A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical