Active NPI
Jenelle N Boo, PH.D.
- Counseling Psychologist
- Indianapolis, IN
National Provider Identifier
1396082806
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 0810004497
- Practice address
- 1481 W 10TH St
Indianapolis, IN 46202-2803 - Phone
- (317) 988-4328
- NPI assigned
- Jan 4, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 0810004497 | VA | Primary |
Addresses
Primary practice location
1481 W 10TH St
Indianapolis, IN 46202-2803
Mailing address
1481 W 10TH St
Indianapolis, IN 46202-2803
Phone (317) 988-4328
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810004497 | VA | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1357257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363305600000",
"number": "1396082806",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1481 W 10TH ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462022803",
"telephone_number": "317-988-4328"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1481 W 10TH ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462022803",
"telephone_number": "317-988-4328"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOO",
"first_name": "JENELLE",
"middle_name": "N",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-01-04",
"last_updated": "2013-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "VA",
"license": "0810004497",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.