Provider Demographics
NPI:1073151239
Name:WORD, TANICKA ELIZABETH (LMHCA)
Entity type:Individual
Prefix:
First Name:TANICKA
Middle Name:ELIZABETH
Last Name:WORD
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:WORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHCA
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:
Practice Address - Street 1:12125 E 65TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-4653
Practice Address - Country:US
Practice Address - Phone:312-248-4062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-19-88946106S00000X
IN88001966A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician