Provider Demographics
NPI:1053770396
Name:SUMPTER, JOHNATHAN MILES (MBA, MA, LPC)
Entity type:Individual
Prefix:MR
First Name:JOHNATHAN
Middle Name:MILES
Last Name:SUMPTER
Suffix:
Gender:M
Credentials:MBA, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4003 SEGRAM COURT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-3330
Mailing Address - Country:US
Mailing Address - Phone:806-463-0068
Mailing Address - Fax:
Practice Address - Street 1:2300 VALLEY VIEW LANE
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:76052
Practice Address - Country:US
Practice Address - Phone:682-777-3988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69523101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health