Healthcare Provider Details

I. General information

NPI: 1891300562
Provider Name (Legal Business Name): JONATHAN DAVID LEONG MA, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. JON LEONG

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4371 PUAOLE ST STE C
LIHUE HI
96766-1275
US

IV. Provider business mailing address

295 NE GILMAN BLVD STE 201
ISSAQUAH WA
98027-2906
US

V. Phone/Fax

Practice location:
  • Phone: 808-652-9190
  • Fax:
Mailing address:
  • Phone: 425-780-5294
  • Fax: 425-677-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61539130
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC1102
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: