Individual
JONATHAN SHACKLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPC, CAADC
Contact information
Practice address
410 S ANGLE ST, MOUNT JOY, PA 17552-2031
(717) 653-1507
Mailing address
410 S ANGLE ST, MOUNT JOY, PA 17552-2031
(717) 653-1507
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PC007789
PA
Other
Enumeration date
09/11/2014
Last updated
09/11/2014
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