Provider Demographics
NPI:1437874260
Name:LEHENABUER, JONATHAN J
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:J
Last Name:LEHENABUER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N WYMORE RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2822
Mailing Address - Country:US
Mailing Address - Phone:407-494-5451
Mailing Address - Fax:
Practice Address - Street 1:315 N WYMORE RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2822
Practice Address - Country:US
Practice Address - Phone:407-494-5451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21250101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health