Provider Demographics
NPI:1558147041
Name:ALLISON, JONATHAN (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:ALLISON
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:JONATHAN
Other - Middle Name:ROBERT
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:1026 TOMASITA ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5536
Mailing Address - Country:US
Mailing Address - Phone:505-221-1275
Mailing Address - Fax:
Practice Address - Street 1:1026 TOMASITA ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5536
Practice Address - Country:US
Practice Address - Phone:505-221-1275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2022-0854101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health