=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932457017
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNN MICHELLE MINTON LCSW, ACSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2012
-----------------------------------------------------
Last Update Date | 03/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2415 MITCHELL RD STE C
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47421-4747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-393-8070
-----------------------------------------------------
Fax | 812-954-5024
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8003 CASTLEWAY DR
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46250-1946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-576-1335
-----------------------------------------------------
Fax | 317-343-6562
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 34004392A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------