Provider Demographics
NPI:1891300562
Name:LEONG, JONATHAN DAVID (MA, LMHCA)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:DAVID
Last Name:LEONG
Suffix:
Gender:M
Credentials:MA, LMHCA
Other - Prefix:MR
Other - First Name:JON
Other - Middle Name:
Other - Last Name:LEONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2830 228TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-9300
Mailing Address - Country:US
Mailing Address - Phone:425-780-5294
Mailing Address - Fax:425-677-7753
Practice Address - Street 1:2830 228TH AVE SE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-9300
Practice Address - Country:US
Practice Address - Phone:425-780-5294
Practice Address - Fax:425-677-7753
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMC61165692101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program