Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 231125 | |
Y | 101YM0800X | Mental Health Counselor | 004235 | NY |
N | 101YP1600X | Pastoral Counselor | ||
N | 101YP2500X | Professional Counselor | C 0500011 | OH |
NPI | 1215067590 |
---|---|
Provider Name | Jonathan D. Durst |
First Address | Phoenix, NY 13135-2182 |
Second Address | Liverpool, NY 13090-1520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 04/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6289140 | UNITED BEHAVIORAL HEALTH (01) | OH |