Provider Demographics
NPI:1952354722
Name:WARNER, JASON ANDREW (PHD, LMFT, LMHC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ANDREW
Last Name:WARNER
Suffix:
Gender:M
Credentials:PHD, LMFT, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 S STATE ROAD 267
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8486
Mailing Address - Country:US
Mailing Address - Phone:317-838-0242
Mailing Address - Fax:
Practice Address - Street 1:459 S STATE ROAD 267
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8486
Practice Address - Country:US
Practice Address - Phone:317-838-0242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001766A101YM0800X
IN35001576A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000388028OtherBLUE CROSS BLUE SHEILD