Healthcare Provider Details

I. General information

NPI: 1952354722
Provider Name (Legal Business Name): JASON ANDREW WARNER PH.D., LMFT, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 S STATE ROAD 267
AVON IN
46123-8486
US

IV. Provider business mailing address

459 S STATE ROAD 267
AVON IN
46123-8486
US

V. Phone/Fax

Practice location:
  • Phone: 317-838-0242
  • Fax:
Mailing address:
  • Phone: 317-838-0242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001766A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001576A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: