Provider Demographics
NPI:1134927239
Name:DOBBINS, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:DOBBINS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N BEACH DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-1632
Mailing Address - Country:US
Mailing Address - Phone:574-297-1193
Mailing Address - Fax:
Practice Address - Street 1:11242 N 1175 W
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-8103
Practice Address - Country:US
Practice Address - Phone:574-297-1193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41120241706380A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health