Provider Demographics
NPI:1972842896
Name:KEARNEY, JONATHAN RAY (MED, LPC, LCDC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:RAY
Last Name:KEARNEY
Suffix:
Gender:M
Credentials:MED, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FOREST CENTER DR
Mailing Address - Street 2:APT#13106
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-5245
Mailing Address - Country:US
Mailing Address - Phone:832-644-5026
Mailing Address - Fax:
Practice Address - Street 1:300 FOREST CENTER DR
Practice Address - Street 2:APT#13106
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-5245
Practice Address - Country:US
Practice Address - Phone:832-644-5026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11957101YA0400X
TX67134101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)