Provider Demographics
NPI:1063857506
Name:COON, JONATHAN DAVID (MA)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:DAVID
Last Name:COON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 W 68TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1812
Mailing Address - Country:US
Mailing Address - Phone:337-802-5202
Mailing Address - Fax:
Practice Address - Street 1:1516 S BOSTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4029
Practice Address - Country:US
Practice Address - Phone:337-802-5202
Practice Address - Fax:918-561-6001
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health