Healthcare Provider Details

I. General information

NPI: 1336700236
Provider Name (Legal Business Name): JASON MATTHEW LYNCH MS, LMHC, LCAC, ADS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2019
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 S 8TH ST STE 300
NOBLESVILLE IN
46060-2633
US

IV. Provider business mailing address

5716 DURHAM CASTLE CT APT 114
INDIANAPOLIS IN
46250-5629
US

V. Phone/Fax

Practice location:
  • Phone: 317-754-0808
  • Fax: 317-983-7383
Mailing address:
  • Phone: 314-306-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39004109A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87001667A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88000903A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: