Healthcare Provider Details

I. General information

NPI: 1790356210
Provider Name (Legal Business Name): JENNIFER HIGGINS MA LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5475 BROADWAY UNIT A157
MERRILLVILLE IN
46410-1647
US

IV. Provider business mailing address

5475 BROADWAY UNIT A157
MERRILLVILLE IN
46410-1647
US

V. Phone/Fax

Practice location:
  • Phone: 219-281-2923
  • Fax:
Mailing address:
  • Phone: 219-281-2923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.013095
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: