Provider Demographics
NPI:1114540549
Name:TOMLIN, JONATHAN JAMES (LPC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JAMES
Last Name:TOMLIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WEST AVE APT 404W
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2667
Mailing Address - Country:US
Mailing Address - Phone:215-776-0493
Mailing Address - Fax:
Practice Address - Street 1:100 WEST AVE APT 404W
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2667
Practice Address - Country:US
Practice Address - Phone:215-776-0493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012402101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty