MEDICARE: JENNIFER CHADWICK LMHC, CSAYC

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	39001220A	IN

General Provider Information

NPI Number	:	1649589292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CHADWICK LMHC, CSAYC

Provider Business Mailing Address
First Line	:	6067 DECATUR BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46241-9606
Country	:	US
Telephone Number	:	317-856-5201
Fax Number	:	317-856-2333

Provider Business Practice Location Address
First Line	:	5757 DECATUR BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46241-9534
Country	:	US
Telephone Number	:	317-455-7245
Fax Number	:	317-455-7276

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

Provider Enumeration Date	:	09/30/2010
Last Update Date	:	09/30/2010

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