Provider Demographics
NPI:1902992563
Name:HODGE, ELLEN (MAPCC,LMHC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:HODGE
Suffix:
Gender:F
Credentials:MAPCC,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 NORTH ALABAMA STREET
Mailing Address - Street 2:SUITE 320
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204
Mailing Address - Country:US
Mailing Address - Phone:317-634-6341
Mailing Address - Fax:317-464-9575
Practice Address - Street 1:615 NORTH ALABAMA STREET
Practice Address - Street 2:SUITE 320
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204
Practice Address - Country:US
Practice Address - Phone:317-634-6341
Practice Address - Fax:317-464-9575
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001708A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor