Provider Demographics
NPI:1841598083
Name:HERSCHBERGER, JENNIFER K (LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:HERSCHBERGER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E CARMEL DR STE 131
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3051
Mailing Address - Country:US
Mailing Address - Phone:317-695-5302
Mailing Address - Fax:
Practice Address - Street 1:600 E CARMEL DR STE 131
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3051
Practice Address - Country:US
Practice Address - Phone:317-695-5302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-12
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001807A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300044625Medicaid
IN201178980AMedicaid