Provider Demographics
NPI:1801253091
Name:JONAS, CASSANDRA REBECCA
Entity type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:REBECCA
Last Name:JONAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 S US HIGHWAY 41
Mailing Address - Street 2:GIBAULT CARE, INC.
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4749
Mailing Address - Country:US
Mailing Address - Phone:812-299-1156
Mailing Address - Fax:812-298-3291
Practice Address - Street 1:6401 S US HIGHWAY 41
Practice Address - Street 2:GIBAULT CARE INC.
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4749
Practice Address - Country:US
Practice Address - Phone:812-299-1156
Practice Address - Fax:812-298-3291
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health