Provider Demographics
NPI:1972019859
Name:NASH, JONATHAN (APC, CMHC, LCPC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:NASH
Suffix:
Gender:
Credentials:APC, CMHC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 STANLEY RD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4359
Mailing Address - Country:US
Mailing Address - Phone:770-427-0147
Mailing Address - Fax:
Practice Address - Street 1:764 E 100 N
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2345
Practice Address - Country:US
Practice Address - Phone:801-655-5450
Practice Address - Fax:385-225-9327
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006219101Y00000X
WI11558-125101YP2500X
AZLPC-23511101YP2500X
IDLCPC-10514101YP2500X
COLPC.0021371101YP2500X
UT11412282-6004261QM0801X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-23511OtherLICENSE
UT11412282-6004OtherLICENSE
WI11558-125OtherLICENSE
IDLCPC-10514OtherLICENSE
COLPC.0021371OtherLICENSE