Provider Demographics
NPI:1952626269
Name:NOVOTNEY, JOSEPH SCOTT (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SCOTT
Last Name:NOVOTNEY
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:NOVOTNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:2410 N GLENDALE DR STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-8909
Mailing Address - Country:US
Mailing Address - Phone:260-432-5181
Mailing Address - Fax:260-432-5692
Practice Address - Street 1:2410 N GLENDALE DR STE A
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-8909
Practice Address - Country:US
Practice Address - Phone:260-432-5181
Practice Address - Fax:260-432-5692
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health