Provider Demographics
NPI:1437216637
Name:ATTEBERRY-BENNETT, JINGER (PHD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:JINGER
Middle Name:
Last Name:ATTEBERRY-BENNETT
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:DR
Other - First Name:JINGER
Other - Middle Name:
Other - Last Name:ATTEBERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD HSPP
Mailing Address - Street 1:10291 N MERIDIAN ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1076
Mailing Address - Country:US
Mailing Address - Phone:317-582-1203
Mailing Address - Fax:317-853-1314
Practice Address - Street 1:10293 N MERIDIAN ST
Practice Address - Street 2:SUITE 180
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1123
Practice Address - Country:US
Practice Address - Phone:317-582-1203
Practice Address - Fax:317-853-1314
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040292A103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100120710AMedicaid
IN063867OtherVALUE OPTIONS I.D. NO.
IN000000182361OtherANTHEM PROVIDER I.D. NO.
IN000000182359OtherANTHEM PROVIDER I.D. NO.
IN10022395OtherENCORE PPO ONE I.D.
INR34161Medicare UPIN
IN063867OtherVALUE OPTIONS I.D. NO.