Provider Demographics
NPI:1912069717
Name:EN, CHAR ELLE (ACSW, LCSW, LMFT)
Entity Type:Individual
Prefix:MS
First Name:CHAR
Middle Name:ELLE
Last Name:EN
Suffix:
Gender:F
Credentials:ACSW, LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 W 100 N
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47993-8103
Mailing Address - Country:US
Mailing Address - Phone:765-762-2049
Mailing Address - Fax:765-762-2191
Practice Address - Street 1:225 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901-1312
Practice Address - Country:US
Practice Address - Phone:765-762-2049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000678A1041C0700X
IN35000178A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist