Provider Demographics
NPI:1750500948
Name:FALL, CRAIG W (LMFT, LCSW)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:W
Last Name:FALL
Suffix:
Gender:M
Credentials:LMFT, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2305
Mailing Address - Country:US
Mailing Address - Phone:317-236-1500
Mailing Address - Fax:317-261-3375
Practice Address - Street 1:1400 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2305
Practice Address - Country:US
Practice Address - Phone:317-236-1500
Practice Address - Fax:317-261-3375
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
IN34001038A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000358512OtherANTHEM