Individual
JEREMY MICHAEL WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LMHCA, NCC
Contact information
Practice address
1308 N MAIN STREET, CROWN POINT, IN 46307
(219) 663-6353
Mailing address
1308 N MAIN ST, CROWN POINT, IN 46307-3278
(410) 610-1635
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39002882A
IN
101YM0800X
Mental Health Counselor
88000022A
IN
Other
Enumeration date
05/25/2014
Last updated
07/21/2022
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