MEDICARE: JONATHAN KLEV KABAT LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	IMF88779	CA
2	106H00000X	Marriage & Family Therapist	129217	CA

General Provider Information

NPI Number	:	1114075330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN KLEV KABAT LMFT

Provider Business Mailing Address
First Line	:	PO BOX 595
Second Line	:
City	:	WEED
State	:	CA
Zip	:	96094-0595
Country	:	US
Telephone Number	:	415-630-2305
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 NELLEN AVE
Second Line	:	SUITE 100
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1104
Country	:	US
Telephone Number	:	415-567-4604
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	03/21/2023

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