=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306239934
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON LUNT LPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2015
-----------------------------------------------------
Last Update Date | 11/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5556 ATLANTA HWY STE 3A
-----------------------------------------------------
City | FLOWERY BRANCH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30542-3552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-895-9458
-----------------------------------------------------
Fax | 770-995-1959
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5556 ATLANTA HWY STE 3A
-----------------------------------------------------
City | FLOWERY BRANCH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30542-3552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-895-9458
-----------------------------------------------------
Fax | 770-995-1959
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC 007960
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------