Active NPI
Jonathan Robert Ambrose, LPC
- Professional Counselor
- Boyertown, PA
National Provider Identifier
1275313124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- PC015318
- Practice address
- 137 Montgomery Ave Ste 105
Boyertown, PA 19512-1300 - Phone
- (800) 689-0250
- NPI assigned
- Sep 28, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PC015318 | PA | Primary |
Addresses
Primary practice location
137 Montgomery Ave Ste 105
Boyertown, PA 19512-1300
Mailing address
1275 19TH St NE
Salem, OR 97301-2253
Phone (717) 380-2059
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC015318 | PA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifegrowth Psychological Services | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Boyertown, PA
- NPI 1396063806
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695859200000",
"number": "1275313124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1275 19TH ST NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973012253",
"telephone_number": "717-380-2059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "137 MONTGOMERY AVE STE 105",
"city": "BOYERTOWN",
"state": "PA",
"postal_code": "195121300",
"telephone_number": "800-689-0250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AMBROSE",
"first_name": "JONATHAN",
"middle_name": "ROBERT",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-09-28",
"last_updated": "2023-09-28",
"certification_date": "2023-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "PA",
"license": "PC015318",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boyertown, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.