Provider Demographics
NPI:1104158641
Name:CLINE, JODI LEIGH (MHC)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LEIGH
Last Name:CLINE
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:IN
Mailing Address - Zip Code:46767-9537
Mailing Address - Country:US
Mailing Address - Phone:260-894-4035
Mailing Address - Fax:
Practice Address - Street 1:200 RIVER RD
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:IN
Practice Address - Zip Code:46767-9537
Practice Address - Country:US
Practice Address - Phone:260-894-4035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YM0800X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health