Provider Demographics
NPI:1669775854
Name:CRANE, JONATHAN E (LCSW)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:E
Last Name:CRANE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 W 500 S STE 9
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2912
Mailing Address - Country:US
Mailing Address - Phone:435-789-6300
Mailing Address - Fax:357-256-3254
Practice Address - Street 1:1140 W 500 S STE 9
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2912
Practice Address - Country:US
Practice Address - Phone:435-789-6300
Practice Address - Fax:435-725-6325
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7717942-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical