Healthcare Provider Details

I. General information

NPI: 1598578320
Provider Name (Legal Business Name): JONATHAN MAULE MS, MA, MFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 JOHNSON AVE
SAN LUIS OBISPO CA
93401-4558
US

IV. Provider business mailing address

2180 JOHNSON AVE
SAN LUIS OBISPO CA
93401-4558
US

V. Phone/Fax

Practice location:
  • Phone: 805-781-4768
  • Fax:
Mailing address:
  • Phone: 805-781-4708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT159274
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: