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General NPI Number Information
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NPI Number | 1407469075
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Entity Type | Individual
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Provider Name | JONATHAN RICHARD LPC
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Gender | Male
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 2702 E 5TH ST
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City | TYLER
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State | TX
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Zip | 75701-5021
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Country | US
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Telephone | 214-886-4244
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Fax |
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Provider Business Mailing Address
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Address Line | 2406 PINEHURST RD
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City | COLUMBIA
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State | SC
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Zip | 29204-2280
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Country | US
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Telephone | 214-886-4244
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 76905
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8708
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License Number State | SC
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