MEDICARE: JENNIFER PHILLIPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	88002593A	IN

General Provider Information

NPI Number	:	1902344732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER PHILLIPS

Provider Business Mailing Address
First Line	:	9114 WAYMEN DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-1258
Country	:	US
Telephone Number	:	219-455-7762
Fax Number	:

Provider Business Practice Location Address
First Line	:	9114 WAYMEN DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-1258
Country	:	US
Telephone Number	:	219-455-7762
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	10/30/2024

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Directions to “ JENNIFER PHILLIPS ” Practice Location

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