Provider Demographics
NPI:1225385651
Name:O'NEAL, JENNIFER L (LMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:6626 E 75TH STREET
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-7561
Mailing Address - Fax:317-355-6096
Practice Address - Street 1:2040 N SHADELAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1711
Practice Address - Country:US
Practice Address - Phone:317-355-1800
Practice Address - Fax:317-355-1803
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002336A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health