Provider Demographics
NPI:1295351724
Name:YUSSMAN, JONATHAN (LPCA)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:YUSSMAN
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 SUNFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6514
Mailing Address - Country:US
Mailing Address - Phone:502-443-4381
Mailing Address - Fax:
Practice Address - Street 1:3102 SUNFIELD CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-6514
Practice Address - Country:US
Practice Address - Phone:203-343-1575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-20
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY263682101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional