MEDICARE: MRS. JEANNETTE MARIE ALICEA

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	99134246A	IN

General Provider Information

NPI Number	:	1659239408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEANNETTE MARIE ALICEA

Provider Business Mailing Address
First Line	:	2049 PORTE DELEAU CT APT 301
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-3725
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3145 45TH ST STE G
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-3292
Country	:	US
Telephone Number	:	331-277-8585
Fax Number	:

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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