Provider Demographics
NPI:1528321700
Name:TORNQUIST, SHARAYAH (LMHC)
Entity type:Individual
Prefix:
First Name:SHARAYAH
Middle Name:
Last Name:TORNQUIST
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 E 98TH ST STE 140
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46280-1964
Mailing Address - Country:US
Mailing Address - Phone:317-214-0863
Mailing Address - Fax:317-569-1767
Practice Address - Street 1:3021 E 98TH ST STE 140
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46280-1964
Practice Address - Country:US
Practice Address - Phone:317-214-0863
Practice Address - Fax:317-569-1767
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002414A101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health