Individual
MICHELLE M ITCZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATR-BC, LMHC
Contact information
Practice address
705 RILEY HOSPITAL DR, INDIANAPOLIS, IN 46202-5109
(812) 201-8623
Mailing address
2145 TOBELLO BLVD, INDIANAPOLIS, IN 46234-7652
(812) 201-8623
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
39002210A
IN
Other
Enumeration date
11/30/2012
Last updated
11/30/2012
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