Individual
MELISSA JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
2040 N SHADELAND AVE STE 250, INDIANAPOLIS, IN 46219-1712
(317) 355-5009
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87000604A
IN
101YM0800X
Mental Health Counselor
Primary
39002394A
IN
Other
Enumeration date
07/17/2017
Last updated
11/18/2020
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