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General NPI Number Information
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NPI Number | 1801749684
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Entity Type | Individual
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Provider Name | JONATHAN PAUL P. BARBOSA
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Gender | Male
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Dates
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Enumeration Date | 02/19/2026
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Last Update Date | 02/19/2026
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Provider Practice Location Address
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Address Line | 377 W VIRGINIA ST
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-5756
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Country | US
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Telephone | 815-707-4806
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Fax |
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Provider Business Mailing Address
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Address Line | 502 MCHENRY AVE APT 103
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City | WOODSTOCK
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State | IL
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Zip | 60098-2975
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Country | US
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Telephone | 815-707-4806
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | IL
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