MEDICARE: KELLY BRIANNE SEIDMAN LMHC

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	101YM0800X	Mental Health Counselor	39005341A	IN

General Provider Information

NPI Number	:	1093681082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY BRIANNE SEIDMAN LMHC

Provider Business Mailing Address
First Line	:	3901 E HAGAN ST STE F
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-8516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8820 S MERIDIAN ST STE 225
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-6064
Country	:	US
Telephone Number	:	317-865-6700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2025
Last Update Date	:	12/10/2025

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