Healthcare Provider Details

I. General information

NPI: 1497706543
Provider Name (Legal Business Name): JONATHAN MICHAEL FILITTI LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2728 ASBURY RD SUITE 950
DUBUQUE IA
52001-2971
US

IV. Provider business mailing address

2728 ASBURY RD SUITE 950
DUBUQUE IA
52001-2971
US

V. Phone/Fax

Practice location:
  • Phone: 563-223-8566
  • Fax:
Mailing address:
  • Phone: 563-223-8566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00898
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: