Provider Demographics
NPI:1336700236
Name:LYNCH, JASON MATTHEW (MS, LMHC, LCAC, ADS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MATTHEW
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MS, LMHC, LCAC, ADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5716 DURHAM CASTLE CT APT 114
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-5629
Mailing Address - Country:US
Mailing Address - Phone:314-306-4401
Mailing Address - Fax:
Practice Address - Street 1:23 S 8TH ST STE 300
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-2633
Practice Address - Country:US
Practice Address - Phone:317-754-0808
Practice Address - Fax:317-983-7383
Is Sole Proprietor?:No
Enumeration Date:2019-06-22
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004109A101YM0800X
IN87001667A101YA0400X
IN88000903A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)