Provider Demographics
NPI:1962776906
Name:ECHTERNACH, KELLYE (MA, LMHC)
Entity type:Individual
Prefix:
First Name:KELLYE
Middle Name:
Last Name:ECHTERNACH
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:KELLYE
Other - Middle Name:
Other - Last Name:CRAMSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:5919 W LAKE DR
Mailing Address - Street 2:APT A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-7911
Mailing Address - Country:US
Mailing Address - Phone:217-653-8712
Mailing Address - Fax:
Practice Address - Street 1:5638 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-5042
Practice Address - Country:US
Practice Address - Phone:317-247-8900
Practice Address - Fax:317-247-8935
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002618A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000623767OtherUBH PIN