Healthcare Provider Details

I. General information

NPI: 1063771459
Provider Name (Legal Business Name): JENNIE KAYE FREELAND MS.ED, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7435 LOMBARDI DR
PLAINFIELD IN
46168-2804
US

IV. Provider business mailing address

7435 LOMBARDI DR
PLAINFIELD IN
46168-2804
US

V. Phone/Fax

Practice location:
  • Phone: 317-995-0328
  • Fax: 317-973-6091
Mailing address:
  • Phone: 317-995-0328
  • Fax: 317-973-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.006853
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39002547A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: