Provider Demographics
NPI:1376066423
Name:AYERS, JONATHAN (LCMHC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:AYERS
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 HARRINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7106
Mailing Address - Country:US
Mailing Address - Phone:802-310-2798
Mailing Address - Fax:
Practice Address - Street 1:150 CHERRY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3818
Practice Address - Country:US
Practice Address - Phone:802-310-2798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT149.0127854101YA0400X
VT068.0125707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)