Provider Demographics
NPI:1063682755
Name:HIRST, JODY L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:L
Last Name:HIRST
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 1:394 VENTANA CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1095
Mailing Address - Country:US
Mailing Address - Phone:317-564-4462
Mailing Address - Fax:
Practice Address - Street 1:6040 W 84TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1360
Practice Address - Country:US
Practice Address - Phone:317-956-6288
Practice Address - Fax:317-956-6289
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001573A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical