Provider Demographics
NPI:1598319048
Name:RUNYAN, PAUL VERNON JR (LMHCA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:VERNON
Last Name:RUNYAN
Suffix:JR
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 REFLECTIONS DR UNIT 8
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214
Mailing Address - Country:US
Mailing Address - Phone:317-522-8689
Mailing Address - Fax:
Practice Address - Street 1:5486 W US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140
Practice Address - Country:US
Practice Address - Phone:317-434-5375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2023-10-27
Deactivation Date:2023-10-02
Deactivation Code:
Reactivation Date:2023-10-27
Provider Licenses
StateLicense IDTaxonomies
IN99090203A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health