Provider Demographics
NPI:1558674994
Name:WHITE, ELIZABETH CLARE (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CLARE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8526 WALDEN TRACE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-5016
Mailing Address - Country:US
Mailing Address - Phone:317-299-5063
Mailing Address - Fax:
Practice Address - Street 1:3003 E 98TH ST
Practice Address - Street 2:SUITE 271
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-1998
Practice Address - Country:US
Practice Address - Phone:317-938-3957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002169A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health