Healthcare Provider Details

I. General information

NPI: 1699255596
Provider Name (Legal Business Name): JANN MARC MONSERRAT LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8913 BROADWAY # 1082
MERRILLVILLE IN
46410-7039
US

IV. Provider business mailing address

8913 BROADWAY # 1082
MERRILLVILLE IN
46410-7039
US

V. Phone/Fax

Practice location:
  • Phone: 562-837-0232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35002594A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162129
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101007681
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2476-124
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: