Provider Demographics
NPI:1447315056
Name:HOLDER, JONATHAN CHRISTOPHER (LMHC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CHRISTOPHER
Last Name:HOLDER
Suffix:
Gender:M
Credentials:LMHC
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 192
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-0192
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4254 E. SURFACE RD.
Practice Address - Street 2:
Practice Address - City:LANGEY
Practice Address - State:WA
Practice Address - Zip Code:98260
Practice Address - Country:US
Practice Address - Phone:360-341-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health