Provider Demographics
NPI:1871005165
Name:DECAL, SHELISE MAHAIA (LMFT)
Entity type:Individual
Prefix:
First Name:SHELISE
Middle Name:MAHAIA
Last Name:DECAL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8710 BASH ST UNIT 50154
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4017
Mailing Address - Country:US
Mailing Address - Phone:442-222-8055
Mailing Address - Fax:
Practice Address - Street 1:8710 BASH ST UNIT 50154
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4017
Practice Address - Country:US
Practice Address - Phone:442-222-8055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
IN35002180A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator