Healthcare Provider Details

I. General information

NPI: 1295112837
Provider Name (Legal Business Name): JENNIFER CAUDILL MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5638 PROFESSIONAL CIR
INDIANAPOLIS IN
46241-5042
US

IV. Provider business mailing address

4133 GOLDEN EAGLE DR
INDIANAPOLIS IN
46234-1307
US

V. Phone/Fax

Practice location:
  • Phone: 888-714-1927
  • Fax: 317-247-8935
Mailing address:
  • Phone: 765-717-3945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001936A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: