Provider Demographics
NPI:1326347311
Name:HARTSELL, JONATHAN LYNN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:LYNN
Last Name:HARTSELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 CHEROKEE RD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3474
Mailing Address - Country:US
Mailing Address - Phone:423-426-4733
Mailing Address - Fax:
Practice Address - Street 1:207 BOONE STREET
Practice Address - Street 2:SUITE 27
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-444-3677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN53911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical