Provider Demographics
NPI:1952917312
Name:MICHAUD, ETHANY OPAL ABBRA (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:ETHANY
Middle Name:OPAL ABBRA
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9957 CROSSPOINT BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3391
Mailing Address - Country:US
Mailing Address - Phone:317-676-9593
Mailing Address - Fax:
Practice Address - Street 1:9957 CROSSPOINT BLVD STE 150
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3391
Practice Address - Country:US
Practice Address - Phone:317-992-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009138A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical