Provider Demographics
NPI:1457773061
Name:STAATS, JASON (LPCC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:STAATS
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 RIO DOSA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1540
Mailing Address - Country:US
Mailing Address - Phone:859-268-6422
Mailing Address - Fax:859-268-6473
Practice Address - Street 1:3050 RIO DOSA DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1540
Practice Address - Country:US
Practice Address - Phone:859-268-6422
Practice Address - Fax:859-268-6473
Is Sole Proprietor?:No
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1094101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional