Provider Demographics
NPI:1013653377
Name:PRICE, JONATHAN A (CADC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:A
Last Name:PRICE
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 E 18TH N
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-1822
Mailing Address - Country:US
Mailing Address - Phone:208-985-3228
Mailing Address - Fax:
Practice Address - Street 1:1140 AMERICAN LEGION BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-2821
Practice Address - Country:US
Practice Address - Phone:208-580-5431
Practice Address - Fax:208-906-8525
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID12974101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)