Provider Demographics
NPI:1891565644
Name:LEGER, JONATHAN B (LPC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:B
Last Name:LEGER
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 1:1411 N FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2637
Mailing Address - Country:US
Mailing Address - Phone:937-426-2686
Mailing Address - Fax:937-426-6230
Practice Address - Street 1:1411 N FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2637
Practice Address - Country:US
Practice Address - Phone:937-426-2686
Practice Address - Fax:937-426-6230
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2406652101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC.2406652OtherLICENSE
OH1891565644OtherNPI