Provider Demographics
NPI:1508587031
Name:MATTINGLY, JARREN PAIGE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JARREN
Middle Name:PAIGE
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MADISON SQ
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-9548
Mailing Address - Country:US
Mailing Address - Phone:765-643-0121
Mailing Address - Fax:
Practice Address - Street 1:2200 MADISON SQ
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-9548
Practice Address - Country:US
Practice Address - Phone:765-643-0121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007335A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical