Provider Demographics
NPI:1053910497
Name:MINTER, ELLEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:MINTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 POLO CLUB DR STE 6
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5870
Mailing Address - Country:US
Mailing Address - Phone:219-810-5372
Mailing Address - Fax:
Practice Address - Street 1:7108 BROADWAY APT 1A
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-3469
Practice Address - Country:US
Practice Address - Phone:219-810-5372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-17
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008991A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical