Provider Demographics
NPI:1215426028
Name:NOTTINGHAM, JEFFREY MICHAEL (LMHC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:NOTTINGHAM
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 N DELAWARE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-4467
Mailing Address - Country:US
Mailing Address - Phone:317-983-5281
Mailing Address - Fax:317-214-8721
Practice Address - Street 1:1505 N DELAWARE ST STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-4467
Practice Address - Country:US
Practice Address - Phone:317-983-5281
Practice Address - Fax:317-214-8721
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003078A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health