Provider Demographics
NPI:1922572155
Name:JONGSMA, JONTAY (LPC)
Entity Type:Individual
Prefix:
First Name:JONTAY
Middle Name:
Last Name:JONGSMA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 PATTERSON RD STE 2-185
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8814
Mailing Address - Country:US
Mailing Address - Phone:970-315-2147
Mailing Address - Fax:
Practice Address - Street 1:2695 PATTERSON RD STE 2-185
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8814
Practice Address - Country:US
Practice Address - Phone:970-315-2147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0018454101YM0800X
COLPCC.0017514101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000206938Medicaid