Provider Demographics
NPI:1336675602
Name:PROUTY, JONATHAN (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:PROUTY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-6774
Mailing Address - Country:US
Mailing Address - Phone:817-255-7150
Mailing Address - Fax:817-255-7166
Practice Address - Street 1:1518 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-6774
Practice Address - Country:US
Practice Address - Phone:817-255-7150
Practice Address - Fax:817-255-7166
Is Sole Proprietor?:No
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62647104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker