Provider Demographics
NPI:1811218027
Name:HENN-CARLSON, ELISABETH (MS, CHT, LMHC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:
Last Name:HENN-CARLSON
Suffix:
Gender:F
Credentials:MS, CHT, LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 E 52ND ST STE 12
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1176
Mailing Address - Country:US
Mailing Address - Phone:317-921-0972
Mailing Address - Fax:
Practice Address - Street 1:740 E 52ND ST STE 12
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1176
Practice Address - Country:US
Practice Address - Phone:317-921-0972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000922A101YM0800X
IN35001142A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist