MEDICARE: CLOVER CROSSROADS COUNSELING, LLC

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

General Provider Information

NPI Number	:	1497683304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLOVER CROSSROADS COUNSELING, LLC

Provider Business Mailing Address
First Line	:	5534 SAINT JOE RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-3328
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1513 25TH ST
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-4387
Country	:	US
Telephone Number	:	812-302-6897
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	KRISTIN WHICKER
Credential	:	LMHC
Telephone Number	:	812-302-6897

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	06/15/2026

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