Provider Demographics
NPI:1073853024
Name:LINDEN, JENELLE (MA, LMHC, LPC, LCPC)
Entity Type:Individual
Prefix:
First Name:JENELLE
Middle Name:
Last Name:LINDEN
Suffix:
Gender:F
Credentials:MA, LMHC, LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 J ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-3847
Mailing Address - Country:US
Mailing Address - Phone:812-902-8007
Mailing Address - Fax:833-212-9488
Practice Address - Street 1:1501 J ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3847
Practice Address - Country:US
Practice Address - Phone:812-902-8007
Practice Address - Fax:833-212-9488
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009603101YM0800X
MI6401017440101YM0800X
IN39002692A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300013338Medicaid