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Individual

MICHELLE LUALLEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW,LCAC

Contact information

Practice address
912 N DELAWARE ST, INDIANAPOLIS, IN 46202-3348
(217) 660-2848
(317) 660-2848
Mailing address
644 E ARCH ST, INDIANAPOLIS, IN 46202-3461
(317) 294-7100

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34005804
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12626384
CAQH
IN
01
34005804A
PROFESSIONAL LICENSE
IN
Enumeration date
01/13/2014
Last updated
03/17/2018
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