Provider Demographics
NPI:1134729981
Name:HOSTETLER, MARK ALAN (LMHC, LCAC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALAN
Last Name:HOSTETLER
Suffix:
Gender:M
Credentials:LMHC, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 N MERIDIAN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1358
Mailing Address - Country:US
Mailing Address - Phone:317-926-5463
Mailing Address - Fax:
Practice Address - Street 1:2105 N MERIDIAN ST STE 102
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1358
Practice Address - Country:US
Practice Address - Phone:317-926-5463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000900A101YA0400X
IN39000022A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)