Individual
DR. MARLYSSA RAE FILLMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
4980 HUNTERS RUN, COLUMBUS, IN 47201-8499
(812) 552-1499
Mailing address
4020 W GOELLER BLVD, ELLIE MENTAL HEALTH, COLUMBUS, IN 47201-8499
(812) 552-1499
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
20043326A
IN
103T00000X
Psychologist
Primary
20043326A
IN
103TC1900X
Counseling Psychologist
20043326A
IN
103TS0200X
School Psychologist
10228724
IN
Other
Enumeration date
07/13/2019
Last updated
10/23/2024
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