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Individual
MR. JONATHAN MICHAEL LEAGUE
Active
Individual
MR. JONATHAN MICHAEL LEAGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPCC, LCDC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
021055
OH
101YP2500X
Professional Counselor
E 4364
OH
106H00000X
Marriage & Family Therapist
E 4364
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000477472
BCBS/ANTHEM ID
OH
Enumeration date
10/27/2006
Last updated
10/07/2009
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