Provider Demographics
NPI:1396949103
Name:DUNCAN, ELISA M (LLC)
Entity type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:M
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-3385
Mailing Address - Country:US
Mailing Address - Phone:812-322-3467
Mailing Address - Fax:812-339-4436
Practice Address - Street 1:1117 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3385
Practice Address - Country:US
Practice Address - Phone:812-322-3467
Practice Address - Fax:812-339-4436
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000600A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty