Provider Demographics
NPI:1598921017
Name:HOSCH, JASON MATTHEW (PHD, LCCC, LMHC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:MATTHEW
Last Name:HOSCH
Suffix:
Gender:M
Credentials:PHD, LCCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4375 US HIGHWAY 17
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4832
Mailing Address - Country:US
Mailing Address - Phone:904-386-9518
Mailing Address - Fax:904-269-0499
Practice Address - Street 1:4375 US HIGHWAY 17
Practice Address - Street 2:SUITE 103
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4832
Practice Address - Country:US
Practice Address - Phone:904-386-9518
Practice Address - Fax:904-269-0499
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5348101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health