Provider Demographics
NPI:1851329593
Name:HALFAST, JEAN A (LCSW, LCAC)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:A
Last Name:HALFAST
Suffix:
Gender:F
Credentials:LCSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1526
Mailing Address - Country:US
Mailing Address - Phone:574-722-5151
Mailing Address - Fax:574-739-1414
Practice Address - Street 1:401 E 8TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-1443
Practice Address - Country:US
Practice Address - Phone:574-223-8565
Practice Address - Fax:574-223-8786
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004818A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN111810013OtherMEDICARE
IN000000184311OtherANTHEM
IN000000184311OtherANTHEM
IN112690AAOtherMEDICARE