Provider Demographics
NPI:1598154023
Name:GURNEY, JONATHAN (ACSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:GURNEY
Suffix:
Gender:M
Credentials:ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 E 56TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3133
Mailing Address - Country:US
Mailing Address - Phone:317-448-3285
Mailing Address - Fax:
Practice Address - Street 1:8515 CEDAR PLACE DR STE 102
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-2343
Practice Address - Country:US
Practice Address - Phone:317-448-3285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040056441041C0700X
IN34003155A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical