MEDICARE: L JEAN HINES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073478442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L JEAN HINES

Provider Business Mailing Address
First Line	:	10918 S SPRINGBORO RD
Second Line	:
City	:	BROOKSTON
State	:	IN
Zip	:	47923-8277
Country	:	US
Telephone Number	:	765-427-8019
Fax Number	:	765-374-2752

Provider Business Practice Location Address
First Line	:	839 MAIN ST STE 500
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47901-2830
Country	:	US
Telephone Number	:	765-427-8019
Fax Number	:	765-374-2752

Authorized Official
Title or Position	:	OWNER
Name	:	JEAN HINES
Credential	:	LCSW
Telephone Number	:	765-427-8019

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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