Provider Demographics
NPI:1245052620
Name:MCINTOSH, JONATHAN SCOTT (LPC)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:SCOTT
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 CHURCH ST STE 312
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-5912
Mailing Address - Country:US
Mailing Address - Phone:920-889-0880
Mailing Address - Fax:
Practice Address - Street 1:1007 CHURCH ST STE 312
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5912
Practice Address - Country:US
Practice Address - Phone:920-889-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178020549101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty