Provider Demographics
NPI:1972012425
Name:TRUMP SNELSON, MONIQUE (LMFT)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:TRUMP SNELSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:SNELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:51387 LAKE POINTE CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-6562
Mailing Address - Country:US
Mailing Address - Phone:574-876-9326
Mailing Address - Fax:
Practice Address - Street 1:51387 LAKE POINTE CT
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-6562
Practice Address - Country:US
Practice Address - Phone:574-876-9326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35002008A106H00000X
IN85000283A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty