Provider Demographics
NPI:1841460201
Name:KNIOLA, JASON A (MS, NCC, LMHC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:KNIOLA
Suffix:
Gender:M
Credentials:MS, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 DIGBY RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-1150
Mailing Address - Country:US
Mailing Address - Phone:765-491-7760
Mailing Address - Fax:
Practice Address - Street 1:106 DIGBY RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-1150
Practice Address - Country:US
Practice Address - Phone:765-491-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-01
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001855A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health