Healthcare Provider Details

I. General information

NPI: 1770407199
Provider Name (Legal Business Name): JONATHAN MICHAEL MARKLEY SUDRC126473
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 N LINCOLN ST
SANTA MARIA CA
93458-2132
US

IV. Provider business mailing address

1404 N LINCOLN ST
SANTA MARIA CA
93458-2132
US

V. Phone/Fax

Practice location:
  • Phone: 805-891-8285
  • Fax:
Mailing address:
  • Phone: 805-891-8285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number26473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: