Provider Demographics
NPI:1609574482
Name:DOAN, JESSICA (MA, LMFTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DOAN
Suffix:
Gender:F
Credentials:MA, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5542 N OLIVIA DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:IN
Mailing Address - Zip Code:46001-8604
Mailing Address - Country:US
Mailing Address - Phone:765-635-7914
Mailing Address - Fax:
Practice Address - Street 1:5542 N OLIVIA DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:IN
Practice Address - Zip Code:46001-8604
Practice Address - Country:US
Practice Address - Phone:765-635-7914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85000499A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist