Provider Demographics
NPI:1467785816
Name:COLLADO, JENNIE (LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:COLLADO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:
Other - Last Name:MIMMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9615 E 148TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4360
Mailing Address - Country:US
Mailing Address - Phone:317-587-0533
Mailing Address - Fax:317-674-0059
Practice Address - Street 1:17840 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-5409
Practice Address - Country:US
Practice Address - Phone:317-773-6864
Practice Address - Fax:317-674-0059
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001745A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist