Healthcare Provider Details

I. General information

NPI: 1902373525
Provider Name (Legal Business Name): JACQUELINE HUXFORD LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 N RITTER AVE
INDIANAPOLIS IN
46219-3026
US

IV. Provider business mailing address

1701 LIBRARY BLVD STE A
GREENWOOD IN
46142-1567
US

V. Phone/Fax

Practice location:
  • Phone: 317-359-5467
  • Fax:
Mailing address:
  • Phone: 317-881-9923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number99088497A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39003396A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: