Jonathan David Douglass, MA, LAC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

37AC00141100 Issued in NJ

Practice address

1750 Zion Rd Ste 209
Northfield, NJ 08225-1844

Phone

(609) 204-6134

Fax

(570) 864-3353

NPI assigned

Nov 18, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1353196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353196800000",
    "number": "1093059859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 ZION RD STE 209",
            "city": "NORTHFIELD",
            "state": "NJ",
            "postal_code": "082251844",
            "telephone_number": "609-204-6134",
            "fax_number": "570-864-3353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 ZION RD STE 209",
            "city": "NORTHFIELD",
            "state": "NJ",
            "postal_code": "082251844",
            "telephone_number": "609-204-6134",
            "fax_number": "570-864-3353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLASS",
        "first_name": "JONATHAN",
        "middle_name": "DAVID",
        "credential": "MA, LAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-18",
        "last_updated": "2012-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "37AC00141100",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NJ",
            "license": "37AC00141100",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NJ",
            "license": "37AC00141100",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Northfield, NJ
• Providers in Northfield, NJ by specialty
• Professional Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.