Healthcare Provider Details

I. General information

NPI: 1669015129
Provider Name (Legal Business Name): JEANNETTE BARCENAS MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 WALL ST STE 42
VALPARAISO IN
46383-2572
US

IV. Provider business mailing address

5240 WOODBRIDGE AVE
PORTAGE IN
46368-4155
US

V. Phone/Fax

Practice location:
  • Phone: 219-510-8043
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39006171A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: