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General NPI Number Information
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NPI Number | 1831348762
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Entity Type | Individual
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Provider Name | JONATHAN D KATZ PSY.D
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Gender | Male
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 1335 GUSDORF RD STE N
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City | TAOS
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State | NM
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Zip | 87571-5208
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Country | US
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Telephone | 312-282-7003
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Fax |
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Provider Business Mailing Address
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Address Line | 1335 GUSDORF RD STE N
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City | TAOS
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State | NM
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Zip | 87571-5208
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Country | US
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Telephone | 312-282-7003
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY1550
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071007880
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License Number State | IL
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