Individual
JENNIFER L REILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
257 INDIANA AVE STE B1, VALPARAISO, IN 46383-5543
(219) 510-7260
Mailing address
4212 ONYX CT, VALPARAISO, IN 46385-7301
(219) 510-7260
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39001660A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000353217
ANTHEM
IN
01
—
39001660A
LMHC
IN
Enumeration date
12/28/2005
Last updated
03/13/2014
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