Healthcare Provider Details

I. General information

NPI: 1073478442
Provider Name (Legal Business Name): L JEAN HINES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 MAIN ST STE 500
LAFAYETTE IN
47901-2830
US

IV. Provider business mailing address

10918 S SPRINGBORO RD
BROOKSTON IN
47923-8277
US

V. Phone/Fax

Practice location:
  • Phone: 765-427-8019
  • Fax: 765-374-2752
Mailing address:
  • Phone: 765-427-8019
  • Fax: 765-374-2752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JEAN HINES
Title or Position: OWNER
Credential: LCSW
Phone: 765-427-8019