Provider Demographics
NPI:1700303948
Name:ANGEL, JONATHAN C (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:C
Last Name:ANGEL
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 BROADWATER AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4811
Mailing Address - Country:US
Mailing Address - Phone:406-876-4936
Mailing Address - Fax:
Practice Address - Street 1:2040 BROADWATER AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4811
Practice Address - Country:US
Practice Address - Phone:406-876-4936
Practice Address - Fax:406-245-1156
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-30178101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional