Provider Demographics
NPI:1144821836
Name:REA, JONATHAN (LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:REA
Suffix:
Gender:M
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17046 GLENEAGLE DR S
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-4614
Mailing Address - Country:US
Mailing Address - Phone:713-377-0251
Mailing Address - Fax:
Practice Address - Street 1:1408B STONEHOLLOW DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2276
Practice Address - Country:US
Practice Address - Phone:713-377-0251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health