Provider Demographics
NPI:1285067645
Name:CHIARAVALLE, JONATHAN (MA)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:CHIARAVALLE
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 1:502 WASHINGTON ST STE 208
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-2270
Mailing Address - Country:US
Mailing Address - Phone:541-705-7045
Mailing Address - Fax:541-769-0723
Practice Address - Street 1:502 WASHINGTON ST STE 208
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2270
Practice Address - Country:US
Practice Address - Phone:541-705-7045
Practice Address - Fax:541-769-0723
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4827101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health