Healthcare Provider Details

I. General information

NPI: 1669462719
Provider Name (Legal Business Name): JACQUELINE A MORICE PHD LSCW LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MISS JACQUELINE A SCRIBNER

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 N KEYSTONE AVE 528
INDIANAPOLIS IN
46220-2452
US

IV. Provider business mailing address

9503 E 86TH ST
INDIANAPOLIS IN
46256-9705
US

V. Phone/Fax

Practice location:
  • Phone: 317-255-7225
  • Fax:
Mailing address:
  • Phone: 317-225-7228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34002286A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35000345A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: