MEDICARE: JONATHAN S STATT LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LMFT-10409	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447570197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN S STATT LMFT

Provider Business Mailing Address
First Line	:	PO BOX 89784
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85752-9784
Country	:	US
Telephone Number	:	520-447-7440
Fax Number	:	520-306-4861

Provider Business Practice Location Address
First Line	:	1022 W INA RD # 103
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-3109
Country	:	US
Telephone Number	:	520-447-7440
Fax Number	:	520-306-4861

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2010
Last Update Date	:	04/21/2016

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