MEDICARE: ANA MENTAL HEALTH COUNSELING, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1932713054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANA MENTAL HEALTH COUNSELING, LLC

Provider Business Mailing Address
First Line	:	10831 SNOWDROP WAY
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-3561
Country	:	US
Telephone Number	:	765-623-6077
Fax Number	:

Provider Business Practice Location Address
First Line	:	10831 SNOWDROP WAY
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-3561
Country	:	US
Telephone Number	:	765-623-6077
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	ASHLEY N JACKSON
Credential	:	LMHC
Telephone Number	:	765-623-6077

Provider Enumeration Date	:	09/04/2020
Last Update Date	:	09/04/2020

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