MELISSA JACK (NPI# 1467974956) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467974956 |
| Entity Type | Individual |
| Full Name | MELISSA JACK |
| Credential | LMHC |
| Practice Address |
2040 N Shadeland Ave Ste 250 Indianapolis IN 46219-1712 |
| Mailing Address |
6626 E 75th St Ste 500 Indianapolis IN 46250-2890 |
| Practice Telephone | 3173555009 |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2019-09-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
87000604A | IN | Behavioral Health & Social Service Providers |
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
39002394A | IN | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 615 N Alabama St Ste 320, Indianapolis, IN 462041432 | 3176346341 | 3174649575 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952642639 | Melissa Jack | Specialist/Technologist | 15826 Roxton Ridge Dr, Webster, TX 77598-2544 | 2013-03-06 |
| Street Address |
2040 N SHADELAND AVE STE 250 |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46219-1712 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952544199 | Theresa Suozzi | Family Medicine | 2040 N Shadeland Ave Ste 250, Indianapolis, IN 46219-1712 | 2009-04-17 |
| 1942847660 | Lauren Skinner | Social Worker | 2040 N Shadeland Ave Ste 250, Indianapolis, IN 46219-1712 | 2019-12-02 |
| 1336501758 | Paulette Napper-hartfield | Counselor | 2040 N Shadeland Ave Ste 250, Indianapolis, IN 46219-1712 | 2016-03-24 |
| 1477920072 | Hazel M Dobyns | Counselor | 2040 N Shadeland Ave Ste 250, Indianapolis, IN 46219 | 2015-08-31 |
| 1225436090 | Zachary Reed | Social Worker | 2040 N Shadeland Ave Ste 250, Indianapolis, IN 46219-1712 | 2014-12-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518571157 | Kara Kathryn Berning | Dietitian, Registered | 2040 N. Shadeland Ave, Suite 130, Indianapolis, IN 46219 | 2020-09-01 |
| 1780223750 | Erin Cannon | Specialist | 1543 N Post Rd, Indianapolis, IN 46219 | 2019-12-23 |
| 1073151239 | Tanicka Elizabeth Word | Behavior Technician | 6635 E 21st Street, West Building, Indianapolis, IN 46219 | 2019-12-18 |
| 1790322527 | Arlington Westend Dental LLC | Dentist | 5900 E 10th St, Indianapolis, IN 46219 | 2019-11-27 |
| 1336645985 | Lynell Westbrook Gates | Counselor | 1311 N Arlington Ave Ste 102, Indianapolis, IN 46219 | 2018-04-03 |
| 1861991689 | Comfort Dental LLC | Clinic/Center | 8151 E 21st St., Indianapolis, Indianapolis, IN 46219 | 2018-02-07 |
| 1467811570 | Fresenius Medical Care Indiana, LLC | Clinic/Center | 6701 E 21st St, Indianapolis, IN 46219 | 2016-02-17 |
| 1992197289 | Casey Baker | Physician Assistant | 1500 N Ritter Ave (medical Associates, LLP), Indianapolis, IN 46219 | 2015-02-24 |
| 1811398407 | Adam Romesser | Pharmacist | 8907 E. 10th St., Indianapolis, IN 46219 | 2014-09-15 |
| 1225448673 | Justin Stauffer | Pharmacist | 5903 E Pleasant Run Parkway North Dr, Indianapolis, IN 46219 | 2014-05-06 |
| Find all providers in zip 46219 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477153914 | Beverli D Mason | Counselor | 10231 Chris Dr, Indianapolis, IN 46229-1875 | 2020-10-26 |
| 1376150656 | Shelia Hall | Counselor | 7422 Carnation Ln, Indianapolis, IN 46214-1066 | 2020-09-30 |
| 1205443090 | Laura Oliver | Counselor | 2274 Valley Creek Way, Indianapolis, IN 46229-1932 | 2020-09-26 |
| 1932714185 | Thrive Counseling Services, LLC | Counselor | 3750 Kentucky Avenue, Indianapolis, IN 46221-2700 | 2020-09-14 |
| 1033735055 | Luv Taylor | Counselor | 4117 Village Trace Blvd, Indianapolis, IN 46254-6222 | 2020-06-25 |
| 1366067159 | Amdaway Ibrahim | Counselor | 4013 Baker Dr, Indianapolis, IN 46235-1573 | 2020-06-08 |
| 1326661836 | Bridge Clinics | Counselor | 3702 E 10th St, Indianapolis, IN 46201-2554 | 2020-05-19 |
| 1457973380 | Anita J Adams | Counselor | 5218 Cornelius Ave, Indianapolis, IN 46208-2512 | 2020-05-14 |
| 1821610213 | Tiffany Lynette Thompson | Counselor | 4308 Ansar Ln, Indianapolis, IN 46254-3128 | 2020-05-08 |
| 1114549615 | Courtney Terrell | Counselor | 1118 N Audubon Rd, Indianapolis, IN 46219-3116 | 2020-05-07 |
| Find all providers in INDIANAPOLIS | ||||
| City | INDIANAPOLIS |
| Zip Code | 46219 |
Please comment or provide details below to improve the information on MELISSA JACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.