Provider Demographics
NPI:1669462719
Name:MORICE, JACQUELINE A (PHD LSCW LMFT)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:A
Last Name:MORICE
Suffix:
Gender:F
Credentials:PHD LSCW LMFT
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:A
Other - Last Name:SCRIBNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9503 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-9705
Mailing Address - Country:US
Mailing Address - Phone:317-225-7228
Mailing Address - Fax:
Practice Address - Street 1:6100 N KEYSTONE AVE
Practice Address - Street 2:528
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2452
Practice Address - Country:US
Practice Address - Phone:317-255-7225
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002286A1041C0700X
IN35000345A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN265980Medicare ID - Type Unspecified