Healthcare Provider Details

I. General information

NPI: 1326081365
Provider Name (Legal Business Name): MARCIA MOUNT FRENCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11244 GARRICK ST
FISHERS IN
46038-1927
US

IV. Provider business mailing address

11244 GARRICK ST
FISHERS IN
46038-1927
US

V. Phone/Fax

Practice location:
  • Phone: 317-842-5764
  • Fax:
Mailing address:
  • Phone: 317-842-5764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004975A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: