Provider Demographics
NPI:1346965829
Name:ASSOULINE, JONATHAN (MA, LMHCA, MHP)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:ASSOULINE
Suffix:
Gender:M
Credentials:MA, LMHCA, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14907 74TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-8233
Mailing Address - Country:US
Mailing Address - Phone:509-280-3925
Mailing Address - Fax:
Practice Address - Street 1:105B W MAIN STE 115
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5329
Practice Address - Country:US
Practice Address - Phone:253-544-5335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61227951101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty