Provider Demographics
NPI:1326878315
Name:TINSLEY, JOHNATHAN (MSSW)
Entity type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:
Last Name:TINSLEY
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8506 PATHFINDER CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-3175
Mailing Address - Country:US
Mailing Address - Phone:502-216-7847
Mailing Address - Fax:
Practice Address - Street 1:1020 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2630
Practice Address - Country:US
Practice Address - Phone:502-585-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY283551101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)