Provider Demographics
NPI:1811369374
Name:VINCENT, JENNIFER (LMHC, CSAYC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:VINCENT
Suffix:
Gender:F
Credentials:LMHC, CSAYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6424 EVANSTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2174
Mailing Address - Country:US
Mailing Address - Phone:603-860-2584
Mailing Address - Fax:
Practice Address - Street 1:6424 EVANSTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2174
Practice Address - Country:US
Practice Address - Phone:603-860-2584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002772A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health