Provider Demographics
NPI:1316445158
Name:DAVIS, JESSICA HEATHER (MA, LMHC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:HEATHER
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8150 E 550 S
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8608
Mailing Address - Country:US
Mailing Address - Phone:765-650-8380
Mailing Address - Fax:317-561-9006
Practice Address - Street 1:450 E 96TH ST STE 500
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-3760
Practice Address - Country:US
Practice Address - Phone:317-680-8009
Practice Address - Fax:317-561-9006
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-26
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IN39003577A101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional