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NPI Code Detail

MEDICARE: JONATHAN RICHARD LMFT

MEDICARE: JONATHAN RICHARD 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
1106H00000XMarriage & Family Therapist114221CA
2390200000XStudent in an Organized Health Care Education/Training ProgramCA
3106H00000XMarriage & Family Therapist141099CA

General Provider Information

NPI Number : 1689228637
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN RICHARD LMFT
Provider Business Mailing Address
First Line : 1206 W 14TH ST
Second Line :
City : UPLAND
State : CA
Zip : 91786-2517
Country : US
Telephone Number : 909-360-8526
Fax Number :
Provider Business Practice Location Address
First Line : 1206 W 14TH ST
Second Line :
City : UPLAND
State : CA
Zip : 91786-2517
Country : US
Telephone Number : 909-360-8526
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2019
Last Update Date : 09/10/2025

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Directions to “ JONATHAN RICHARD LMFT” Practice Location

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