Provider Demographics
NPI:1487369385
Name:JERRETT, SUZANNE (LMHCA)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:JERRETT
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:689 E 1100 N
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46391-9449
Mailing Address - Country:US
Mailing Address - Phone:315-247-7177
Mailing Address - Fax:
Practice Address - Street 1:689 E 1100 N
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46391-9449
Practice Address - Country:US
Practice Address - Phone:315-247-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88001781A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health