Individual
LAURA LYNN ELLSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LMHC
Contact information
Practice address
929 S KENMORE DR, EVANSVILLE, IN 47714-7514
(812) 760-7722
Mailing address
929 S KENMORE DR, EVANSVILLE, IN 47714-7514
(812) 760-7722
(812) 379-8122
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
39000307A
IN
101YM0800X
Mental Health Counselor
Primary
39000307A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11659278
CAQH PROVIDER ID
IN
Enumeration date
12/11/2006
Last updated
01/04/2025
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