Provider Demographics
NPI:1710612809
Name:MINKALIS, JACQUELINE E (NCC, LMHCA)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:E
Last Name:MINKALIS
Suffix:
Gender:F
Credentials:NCC, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 HIGHWAY AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-1662
Mailing Address - Country:US
Mailing Address - Phone:219-209-2159
Mailing Address - Fax:
Practice Address - Street 1:1355 COBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-6337
Practice Address - Country:US
Practice Address - Phone:708-516-5271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000492A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health