Provider Demographics
NPI:1164645529
Name:CRANE, JEAN MICHELLE (MA)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:MICHELLE
Last Name:CRANE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 E SOUTHPORT RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-8592
Mailing Address - Country:US
Mailing Address - Phone:317-782-7536
Mailing Address - Fax:317-782-6929
Practice Address - Street 1:650 E SOUTHPORT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8592
Practice Address - Country:US
Practice Address - Phone:317-782-6503
Practice Address - Fax:317-782-6929
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001648A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health