Healthcare Provider Details

I. General information

NPI: 1275852394
Provider Name (Legal Business Name): JONATHAN LENT PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 JAVIT CT STE B
AUSTINTOWN OH
44515-2442
US

IV. Provider business mailing address

107 JAVIT CT STE B
AUSTINTOWN OH
44515-2442
US

V. Phone/Fax

Practice location:
  • Phone: 330-270-1400
  • Fax: 330-270-1404
Mailing address:
  • Phone: 330-270-1400
  • Fax: 330-270-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0800142
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: