Provider Demographics
NPI:1629383617
Name:CAPIO, JONNA MARIE (LMHC, MS, EDS)
Entity Type:Individual
Prefix:
First Name:JONNA
Middle Name:MARIE
Last Name:CAPIO
Suffix:
Gender:F
Credentials:LMHC, MS, EDS
Other - Prefix:
Other - First Name:JONNA
Other - Middle Name:M
Other - Last Name:RISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, MS
Mailing Address - Street 1:4972 E HERITAGE WOODS RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-9175
Mailing Address - Country:US
Mailing Address - Phone:812-331-7773
Mailing Address - Fax:812-822-1218
Practice Address - Street 1:205 N COLLEGE AVE
Practice Address - Street 2:SUITE 430
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3950
Practice Address - Country:US
Practice Address - Phone:812-331-7773
Practice Address - Fax:812-822-1218
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002467A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health