Healthcare Provider Details

I. General information

NPI: 1558400796
Provider Name (Legal Business Name): JONATHAN PORTEUS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8912 VOLUNTEER LN STE 100
SACRAMENTO CA
95826-3224
US

IV. Provider business mailing address

3104 O ST # 336
SACRAMENTO CA
95816-6519
US

V. Phone/Fax

Practice location:
  • Phone: 916-368-3080
  • Fax:
Mailing address:
  • Phone: 916-743-3022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY19635
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number14792
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number14792
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19635
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number14792
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY19635
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number14792
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY19635
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number14792
License Number StateNY
# 10
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY19635
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: