MEDICARE: MS. HELEN THERESE SEIFERT LCSW

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	34003863A	IN

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
2	000000361333	OTHER	IN	BCBS PIN #

General Provider Information

NPI Number	:	1295757680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HELEN THERESE SEIFERT LCSW

Provider Business Mailing Address
First Line	:	2504 W 600 N
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906
Country	:	US
Telephone Number	:	765-714-2434
Fax Number	:	765-497-2440

Provider Business Practice Location Address
First Line	:	2504 W 600 N
Second Line	:
City	:	WEST LAFAYETTE BRA
State	:	IN
Zip	:	47906-9034
Country	:	US
Telephone Number	:	765-714-2434
Fax Number	:	765-497-2440

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/09/2007

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