Provider Demographics
NPI:1396837415
Name:THE JONAS CENTER, INC.
Entity Type:Organization
Organization Name:THE JONAS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:JONAS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, LMFT
Authorized Official - Phone:612-201-6654
Mailing Address - Street 1:107 PAUL AVE N
Mailing Address - Street 2:
Mailing Address - City:COLOGNE
Mailing Address - State:MN
Mailing Address - Zip Code:55322-9330
Mailing Address - Country:US
Mailing Address - Phone:612-201-6654
Mailing Address - Fax:952-466-2709
Practice Address - Street 1:107 PAUL AVE N
Practice Address - Street 2:
Practice Address - City:COLOGNE
Practice Address - State:MN
Practice Address - Zip Code:55322-9330
Practice Address - Country:US
Practice Address - Phone:612-201-6654
Practice Address - Fax:320-864-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43531041C0700X
MN660106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5145252Medicaid