Provider Demographics
NPI:1467168278
Name:HOCKEMEYER, JONATHAN MILES (LCDC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MILES
Last Name:HOCKEMEYER
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23655 HORSESHOE BND
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-3663
Mailing Address - Country:US
Mailing Address - Phone:936-333-4649
Mailing Address - Fax:
Practice Address - Street 1:3513 N FRAZIER ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77303-1430
Practice Address - Country:US
Practice Address - Phone:936-648-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health