| 1 Identity Counseling, Llc | |
|
1501 J St Bedford IN 47421-3847 | |
| (812) 902-8007 | |
| Not Available |
| Full Name | 1 Identity Counseling, Llc |
|---|---|
| Speciality | Counselor |
| Location | 1501 J St, Bedford, Indiana |
| Authorized Official Name and Position | Jenelle Linden (MEMBER OWNER) |
| Authorized Official Contact | 8129028007 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 1 Identity Counseling, Llc 1501 J St Bedford IN 47421-3847 Ph: (812) 902-8007 | 1 Identity Counseling, Llc 1501 J St Bedford IN 47421-3847 Ph: (812) 902-8007 |
| NPI Number | 1740795640 |
|---|---|
| Provider Enumeration Date | 12/13/2017 |
| Last Update Date | 04/16/2021 |
| Certification Date | 04/16/2021 |
| Medicare PECOS PAC ID | 6204378193 |
|---|---|
| Medicare Enrollment ID | O20240606002709 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740795640 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 39002692A (Indiana) | Primary |
| Provider Name | Jenelle Linden |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073853024 PECOS PAC ID: 7012459902 Enrollment ID: I20240606002778 |
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