Healthcare Provider Details

I. General information

NPI: 1689959165
Provider Name (Legal Business Name): JASON ROBERT HOHNSTOCK L.M.H.C.; B.C.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 LAKE ELLENOR DR
ORLANDO FL
32809-5749
US

IV. Provider business mailing address

3500 DEPAUW BLVD STE 3070
INDIANAPOLIS IN
46268-6135
US

V. Phone/Fax

Practice location:
  • Phone: 321-655-6585
  • Fax: 317-520-8200
Mailing address:
  • Phone: 463-223-4591
  • Fax: 317-520-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 6363
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-04-1685
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: