Provider Demographics
NPI:1912286014
Name:WAHMAN, JANICE H (LCSW, LMHC)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:H
Last Name:WAHMAN
Suffix:
Gender:F
Credentials:LCSW, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6640 INTECH BLVD
Mailing Address - Street 2:STE 195
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-2011
Mailing Address - Country:US
Mailing Address - Phone:317-295-0608
Mailing Address - Fax:317-295-0622
Practice Address - Street 1:6640 INTECH BLVD
Practice Address - Street 2:STE 195
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-2011
Practice Address - Country:US
Practice Address - Phone:317-295-0608
Practice Address - Fax:317-295-0622
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001055A101YM0800X
IN34000376A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400054595Medicare PIN