Provider Demographics
NPI:1245700897
Name:BEHROUZVAZIRI, AMBER (LMHC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BEHROUZVAZIRI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:ELLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10255 COMMERCE DR STE 204
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7433
Mailing Address - Country:US
Mailing Address - Phone:812-200-6377
Mailing Address - Fax:
Practice Address - Street 1:10255 COMMERCE DR STE 204
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7433
Practice Address - Country:US
Practice Address - Phone:812-200-6377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003409A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health