Individual
ELISE MALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LMHC
Contact information
Practice address
1251 N EDDY ST STE 200, SOUTH BEND, IN 46617-1478
(574) 208-3776
Mailing address
1251 N EDDY ST STE 200, SOUTH BEND, IN 46617-1478
(574) 208-3776
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39002174A
IN
Other
Enumeration date
10/16/2012
Last updated
01/29/2022
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