Provider Demographics
NPI:1689649246
Name:BROWN, JONATHAN S (PCC CCDC III)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:S
Last Name:BROWN
Suffix:
Gender:M
Credentials:PCC CCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:OH
Mailing Address - Zip Code:43357-0817
Mailing Address - Country:US
Mailing Address - Phone:937-599-1975
Mailing Address - Fax:937-599-2769
Practice Address - Street 1:118 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BELLLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:53311
Practice Address - Country:US
Practice Address - Phone:937-599-1975
Practice Address - Fax:937-599-2769
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001177101YA0400X
OHE0003396101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional