Provider Demographics
NPI:1720805583
Name:MCDERMOTT, JUSTINE (LMHCA)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 BENTEE WES CT
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-4037
Mailing Address - Country:US
Mailing Address - Phone:812-401-1836
Mailing Address - Fax:812-401-8013
Practice Address - Street 1:530 BENTEE WES CT
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4037
Practice Address - Country:US
Practice Address - Phone:812-401-1836
Practice Address - Fax:812-401-8013
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88002567A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health