Provider Demographics
NPI:1548567688
Name:SMITH, JONATHAN ROY (CADC II)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ROY
Last Name:SMITH
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 W. 12TH AVE.
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3008
Mailing Address - Country:US
Mailing Address - Phone:541-344-0031
Mailing Address - Fax:541-344-0772
Practice Address - Street 1:149 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6215
Practice Address - Country:US
Practice Address - Phone:541-344-0031
Practice Address - Fax:541-344-0772
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR930569684101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health