Provider Demographics
NPI:1386290757
Name:SOILEAU, JONATHAN CALEB (PLPC, LPC, NCC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CALEB
Last Name:SOILEAU
Suffix:
Gender:M
Credentials:PLPC, LPC, NCC
Other - Prefix:
Other - First Name:JON
Other - Middle Name:
Other - Last Name:SOILEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PLPC, LPC, NCC
Mailing Address - Street 1:1508 NW VIVION RD STE 300
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4557
Mailing Address - Country:US
Mailing Address - Phone:816-895-2515
Mailing Address - Fax:
Practice Address - Street 1:1508 NW VIVION RD STE 300
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4557
Practice Address - Country:US
Practice Address - Phone:816-895-2515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3437101YP2500X
MO2019029464101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty