MEDICARE: CHARLES ALLAN HUNT LMHCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	88002537A	IN

General Provider Information

NPI Number	:	1124843776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES ALLAN HUNT LMHCA

Provider Business Mailing Address
First Line	:	945 N OXFORD ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-2465
Country	:	US
Telephone Number	:	970-405-6624
Fax Number	:

Provider Business Practice Location Address
First Line	:	6296 RUCKER RD STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4852
Country	:	US
Telephone Number	:	317-550-3043
Fax Number	:	855-845-3260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2024
Last Update Date	:	11/19/2024

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