Provider Demographics
NPI:1649532490
Name:ETNIER, JEANETTE (LMHC, LCAC)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:ETNIER
Suffix:
Gender:F
Credentials:LMHC, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-7443
Mailing Address - Country:US
Mailing Address - Phone:317-881-3363
Mailing Address - Fax:
Practice Address - Street 1:649 JACKSON RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-7443
Practice Address - Country:US
Practice Address - Phone:317-427-6355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000652A101YA0400X, 101YM0800X
IN39001876A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)