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Individual

MARLA D MINTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSSW LCSW

Contact information

Practice address
1101 N ROYAL AVE, SUITE B, EVANSVILLE, IN 47715-7845
(812) 420-0020
(812) 789-2458
Mailing address
PO BOX 8082, EVANSVILLE, IN 47716-8082
(812) 420-0020
(812) 789-2458

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
39001064A
IN
1041C0700X
Clinical Social Worker
Primary
34003950A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000752449
ANTHEM
IN
01
11609129
CAQH
IN
Enumeration date
08/12/2006
Last updated
07/01/2013
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