Provider Demographics
NPI:1073936068
Name:BONT, JORDAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:
Last Name:BONT
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 1:12711 EVERGREEN FARMS LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8004
Mailing Address - Country:US
Mailing Address - Phone:231-519-1693
Mailing Address - Fax:
Practice Address - Street 1:8 E BRIDGE ST
Practice Address - Street 2:SUITE E1
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1601
Practice Address - Country:US
Practice Address - Phone:231-519-1693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013860101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor