Provider Demographics
NPI:1588259162
Name:MCCHRISTIAN, JENNIFER MERIEL (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MERIEL
Last Name:MCCHRISTIAN
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 1:529 TANNINGER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-9457
Mailing Address - Country:US
Mailing Address - Phone:317-869-5008
Mailing Address - Fax:
Practice Address - Street 1:2502 E UNIVERSITY DR STE 240
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-6956
Practice Address - Country:US
Practice Address - Phone:317-210-2796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006370A1041C0700X
AZLCSW-186341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMSWB-2022-0302OtherLCSW
IN34006370AOtherLCSW
AZLCSW-18634OtherLCSW