Healthcare Provider Details

I. General information

NPI: 1629339627
Provider Name (Legal Business Name): JOYCE JOANN KNUTTI M.F.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 S US HIGHWAY 41
TERRE HAUTE IN
47802-4749
US

IV. Provider business mailing address

6401 S US HIGHWAY 41
TERRE HAUTE IN
47802-4749
US

V. Phone/Fax

Practice location:
  • Phone: 812-299-1156
  • Fax: 812-298-3291
Mailing address:
  • Phone: 812-299-1156
  • Fax: 812-298-3291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35000518A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: