Provider Demographics
NPI:1245497973
Name:ROBERTSON, JENNIFER G (LMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:G
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:G
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:384 N MADISON AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-2304
Mailing Address - Country:US
Mailing Address - Phone:317-835-3411
Mailing Address - Fax:317-672-6401
Practice Address - Street 1:6240 E ABLINGTON CT
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-9654
Practice Address - Country:US
Practice Address - Phone:317-835-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002508A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health