Provider Demographics
NPI:1033353859
Name:KNARR, MARY KATRINA (LMHC, LCAC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATRINA
Last Name:KNARR
Suffix:
Gender:F
Credentials:LMHC, LCAC
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:KNARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:610 N LEBANON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1716
Mailing Address - Country:US
Mailing Address - Phone:765-680-0071
Mailing Address - Fax:765-680-0071
Practice Address - Street 1:407 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1852
Practice Address - Country:US
Practice Address - Phone:765-680-0071
Practice Address - Fax:765-680-0468
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000850A101YA0400X
IN39002909A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9149764Medicare UPIN
OH24-01Medicaid