MEDICARE: MR. MARK ALAN HOSTETLER LMHC, LCAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	87000900A	IN
2	101YM0800X	Mental Health Counselor	39000022A	IN

General Provider Information

NPI Number	:	1134729981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK ALAN HOSTETLER LMHC, LCAC

Provider Business Mailing Address
First Line	:	2105 N MERIDIAN ST STE 102
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1358
Country	:	US
Telephone Number	:	317-926-5463
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 N MERIDIAN ST STE 102
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1358
Country	:	US
Telephone Number	:	317-926-5463
Fax Number	:

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

Provider Enumeration Date	:	10/30/2020
Last Update Date	:	10/30/2020

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