Provider Demographics
NPI:1457823593
Name:PRESCOTT, JONATHAN (BCC, BCCC, BCPC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:PRESCOTT
Suffix:
Gender:M
Credentials:BCC, BCCC, BCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7133 GLENCOE LN
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-8913
Mailing Address - Country:US
Mailing Address - Phone:360-929-6996
Mailing Address - Fax:
Practice Address - Street 1:7133 GLENCOE LN
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-8913
Practice Address - Country:US
Practice Address - Phone:360-929-6996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral