Provider Demographics
NPI:1689290645
Name:NAVARRA, NICOLE ELIZABETH (MA, MFT, CSAYC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:NAVARRA
Suffix:
Gender:F
Credentials:MA, MFT, CSAYC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ELIZABETH
Other - Last Name:NAVARRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MFT, CSAYC
Mailing Address - Street 1:927 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3582
Mailing Address - Country:US
Mailing Address - Phone:317-366-9639
Mailing Address - Fax:
Practice Address - Street 1:3307 W 96TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1106
Practice Address - Country:US
Practice Address - Phone:317-876-3699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist