Provider Demographics
NPI:1043911548
Name:LEY, JASON LLOYD
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LLOYD
Last Name:LEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-1431
Mailing Address - Country:US
Mailing Address - Phone:317-313-1370
Mailing Address - Fax:
Practice Address - Street 1:1103 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1431
Practice Address - Country:US
Practice Address - Phone:317-313-1370
Practice Address - Fax:317-350-2939
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33010769A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker