Provider Demographics
NPI:1104392414
Name:KING, JASON (LMHC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 NW 4TH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47708-1356
Mailing Address - Country:US
Mailing Address - Phone:812-422-6812
Mailing Address - Fax:812-288-1113
Practice Address - Street 1:257 BRUCKE STRASSE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3400
Practice Address - Country:US
Practice Address - Phone:812-481-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003270A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health