Healthcare Provider Details

I. General information

NPI: 1437523198
Provider Name (Legal Business Name): JONATHAN GOODBAN M.A., LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W THOUSAND OAKS BLVD STE 300
THOUSAND OAKS CA
91360-4460
US

IV. Provider business mailing address

1911 WILLIAMS DR STE 165
OXNARD CA
93036-2612
US

V. Phone/Fax

Practice location:
  • Phone: 805-418-9100
  • Fax:
Mailing address:
  • Phone: 805-981-4233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF94021
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number127207
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: