Provider Demographics
NPI:1962282319
Name:ELLERMAN, MICHELLE DAWN (LMHCA, ATR-P)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DAWN
Last Name:ELLERMAN
Suffix:
Gender:
Credentials:LMHCA, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1251
Mailing Address - Country:US
Mailing Address - Phone:812-790-2599
Mailing Address - Fax:
Practice Address - Street 1:105 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1251
Practice Address - Country:US
Practice Address - Phone:812-790-2599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88002155A101YM0800X
IN1583231101YS0200X
IN23-204221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool