Provider Demographics
NPI:1508487166
Name:KULL, JONATHAN HARRISON (LPC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:HARRISON
Last Name:KULL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MEAD AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-2340
Mailing Address - Country:US
Mailing Address - Phone:908-209-8173
Mailing Address - Fax:
Practice Address - Street 1:7 MEAD AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-2340
Practice Address - Country:US
Practice Address - Phone:908-209-8173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015566101YP2500X
NJ37PC00915500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional