Provider Demographics
NPI:1205625233
Name:DEGENHARDT, JESSICA LYNNE (LMHC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:DEGENHARDT
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 AMES DR
Mailing Address - Street 2:
Mailing Address - City:WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-1851
Mailing Address - Country:US
Mailing Address - Phone:317-720-1220
Mailing Address - Fax:
Practice Address - Street 1:251 AMES DR
Practice Address - Street 2:
Practice Address - City:WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-1851
Practice Address - Country:US
Practice Address - Phone:317-720-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004754A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health