Basic Information
| Provider Information | |||||||||
| NPI: | 1588182711 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BACHMAN | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC, CAADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 842 COLUMBIA AVE E | ||||||||
| Address2: | |||||||||
| City: | BATTLE CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490145449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2697531710 | ||||||||
| FaxNumber: | 2697531717 | ||||||||
| Practice Location | |||||||||
| Address1: | 842 COLUMBIA AVE E | ||||||||
| Address2: | |||||||||
| City: | BATTLE CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490145449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2697531710 | ||||||||
| FaxNumber: | 2697531717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2017 | ||||||||
| LastUpdateDate: | 10/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | C-03819 | MI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 6401019345 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.