Provider Demographics
NPI:1790806206
Name:MONTRIE, JACQUELYN G (MA, LMFT, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:G
Last Name:MONTRIE
Suffix:
Gender:F
Credentials:MA, LMFT, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3091 E 98TH ST STE 125
Mailing Address - Street 2:WELLSPRING COUNSELING
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-2910
Mailing Address - Country:US
Mailing Address - Phone:317-571-1447
Mailing Address - Fax:
Practice Address - Street 1:3091 E 98TH ST STE 125
Practice Address - Street 2:WELLSPRING COUNSELING
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-2910
Practice Address - Country:US
Practice Address - Phone:317-571-1447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000844A101YM0800X
IN35001440A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist