| Jonna Marie Capio Lmhc Llc | |
|
3925 E Hagan St Ste 307 Bloomington IN 47401-8649 | |
| (812) 331-7773 | |
| Not Available |
| Full Name | Jonna Marie Capio Lmhc Llc |
|---|---|
| Speciality | Counselor |
| Location | 3925 E Hagan St Ste 307, Bloomington, Indiana |
| Authorized Official Name and Position | Jonna M Capio (TIN OWNER) |
| Authorized Official Contact | 8123317773 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jonna Marie Capio Lmhc Llc 4972 E Heritage Woods Rd Bloomington IN 47401-9175 Ph: (812) 331-7773 | Jonna Marie Capio Lmhc Llc 3925 E Hagan St Ste 307 Bloomington IN 47401-8649 Ph: (812) 331-7773 |
| NPI Number | 1740789635 |
|---|---|
| Provider Enumeration Date | 02/06/2018 |
| Last Update Date | 02/06/2018 |
| Medicare PECOS PAC ID | 6103266929 |
|---|---|
| Medicare Enrollment ID | O20240426002290 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740789635 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 39002467A (Indiana) | Primary |
| 101YM0800X | Counselor - Mental Health | 39002467A (Indiana) | Secondary |
| Provider Name | Jonna Marie Capio |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629383617 PECOS PAC ID: 7911347737 Enrollment ID: I20240426002449 |
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