Provider Demographics
NPI:1770331043
Name:CARTER, AUDRA (LMFT)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5469 HAMMOCK GLEN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-9780
Mailing Address - Country:US
Mailing Address - Phone:317-999-3607
Mailing Address - Fax:
Practice Address - Street 1:11 MUNICIPAL DR STE 200
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1634
Practice Address - Country:US
Practice Address - Phone:317-662-4568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF.2400416106H00000X
IN35002401A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist