Provider Demographics
NPI:1417265190
Name:GUY, JACQUELINE LOUISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:LOUISE
Last Name:GUY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:LOUISE
Other - Last Name:SHARPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3171 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4784
Mailing Address - Country:US
Mailing Address - Phone:317-941-5010
Mailing Address - Fax:317-931-5140
Practice Address - Street 1:3171 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4784
Practice Address - Country:US
Practice Address - Phone:317-941-5010
Practice Address - Fax:317-931-5140
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006061A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical