Provider Demographics
NPI:1164447223
Name:LINK, JASON THOMAS (LPC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:THOMAS
Last Name:LINK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 CHURCH ST STE 132
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2894
Mailing Address - Country:US
Mailing Address - Phone:814-243-1563
Mailing Address - Fax:
Practice Address - Street 1:655 CHURCH ST STE 132
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2894
Practice Address - Country:US
Practice Address - Phone:814-243-1563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA13052101YP2500X
TN1496101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4026326OtherBLUE CROSS/ BLUE SHIELD