Provider Demographics
NPI:1548806417
Name:MCDANIEL, JULIETTE ELIZABETH (LMFT)
Entity Type:Individual
Prefix:
First Name:JULIETTE
Middle Name:ELIZABETH
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JULIETTE
Other - Middle Name:ELIZABETH
Other - Last Name:ROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9615 E 148TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4371
Mailing Address - Country:US
Mailing Address - Phone:317-587-0512
Mailing Address - Fax:
Practice Address - Street 1:1600 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2388
Practice Address - Country:US
Practice Address - Phone:765-482-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35002088A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist