Provider Demographics
NPI:1184149197
Name:CANTY, JONATHAN SCOTT (CAC II)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:SCOTT
Last Name:CANTY
Suffix:
Gender:M
Credentials:CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8122
Mailing Address - Country:US
Mailing Address - Phone:970-208-1130
Mailing Address - Fax:970-208-1132
Practice Address - Street 1:2802 ELM AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-4908
Practice Address - Country:US
Practice Address - Phone:970-208-3089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CO101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor