Provider Demographics
NPI:1073630323
Name:BREWER, JOLYN AGNES (LMHC)
Entity Type:Individual
Prefix:
First Name:JOLYN
Middle Name:AGNES
Last Name:BREWER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9247 N MERIDIAN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1813
Mailing Address - Country:US
Mailing Address - Phone:317-418-0597
Mailing Address - Fax:317-815-6031
Practice Address - Street 1:9247 N MERIDIAN ST STE 104
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1813
Practice Address - Country:US
Practice Address - Phone:317-418-0597
Practice Address - Fax:317-815-6031
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000965A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270530AMedicaid
IN150074Medicare PIN