Provider Demographics
NPI:1598920845
Name:MATHIAS, CARLABETH E (LCSW, LMHC)
Entity Type:Individual
Prefix:
First Name:CARLABETH
Middle Name:E
Last Name:MATHIAS
Suffix:
Gender:F
Credentials:LCSW, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10553 BALROYAL CT
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-8846
Mailing Address - Country:US
Mailing Address - Phone:317-578-1195
Mailing Address - Fax:
Practice Address - Street 1:11650 LANTERN RD
Practice Address - Street 2:SUITE 136
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2993
Practice Address - Country:US
Practice Address - Phone:317-578-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000418A101YM0800X
IN34002732A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health