Provider Demographics
NPI:1952635054
Name:SMITH, JONATHAN PETER (MED)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PETER
Last Name:SMITH
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 VAN GIESEN ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354
Mailing Address - Country:US
Mailing Address - Phone:509-943-2590
Mailing Address - Fax:509-946-1398
Practice Address - Street 1:2139 VAN GIESEN ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354
Practice Address - Country:US
Practice Address - Phone:509-943-2590
Practice Address - Fax:509-946-1398
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7407554Medicaid