Provider Demographics
NPI:1871030668
Name:EDWARDS, JONATHAN (MED, NCC, LPC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 N ATHERTON ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-1544
Mailing Address - Country:US
Mailing Address - Phone:814-237-0567
Mailing Address - Fax:814-237-0569
Practice Address - Street 1:2214 N ATHERTON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-1544
Practice Address - Country:US
Practice Address - Phone:814-237-0567
Practice Address - Fax:814-237-0569
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health