=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033721212
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMANTHA JO KNARR LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2020
-----------------------------------------------------
Last Update Date | 03/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3541 S LAFOUNTAIN ST
-----------------------------------------------------
City | KOKOMO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46902-3804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-426-0702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5536 GOLDEN GATE WAY
-----------------------------------------------------
City | KOKOMO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46902-5652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-480-4214
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 39003791A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------