Healthcare Provider Details

I. General information

NPI: 1841845716
Provider Name (Legal Business Name): JONATHAN PAPPAS MARRIAGE FAMILY THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E THOUSAND OAKS BLVD STE 225
THOUSAND OAKS CA
91360-8132
US

IV. Provider business mailing address

100 E THOUSAND OAKS BLVD STE 225
THOUSAND OAKS CA
91360-8132
US

V. Phone/Fax

Practice location:
  • Phone: 805-320-5712
  • Fax:
Mailing address:
  • Phone: 805-320-5712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN PAPPAS
Title or Position: OWNER
Credential:
Phone: 805-320-5712