Provider Demographics
NPI:1336911213
Name:LU, JONATHAN CHARLES RAMOS (DBH, MCHES, ACE-CHC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CHARLES RAMOS
Last Name:LU
Suffix:
Gender:M
Credentials:DBH, MCHES, ACE-CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 SUGAR RUN TRL
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-1149
Mailing Address - Country:US
Mailing Address - Phone:253-441-8805
Mailing Address - Fax:
Practice Address - Street 1:18522 BALD HILL RD SE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7969
Practice Address - Country:US
Practice Address - Phone:253-441-8805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146L00000X, 174H00000X, 171000000X, 171400000X
OHAPS.004984175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No171000000XOther Service ProvidersMilitary Health Care Provider
No171400000XOther Service ProvidersHealth & Wellness Coach
No175T00000XOther Service ProvidersPeer Specialist