Provider Demographics
NPI:1952099780
Name:SEALS, JONATHAN (MSCJ, LCDC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:SEALS
Suffix:
Gender:M
Credentials:MSCJ, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8711 BIRD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-2619
Mailing Address - Country:US
Mailing Address - Phone:713-933-5017
Mailing Address - Fax:
Practice Address - Street 1:3520 BURKE RD APT 159
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1899
Practice Address - Country:US
Practice Address - Phone:713-933-5017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15862101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)