Provider Demographics
NPI:1225182819
Name:MCWHORTER, JON EDEL (MFT)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:EDEL
Last Name:MCWHORTER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 BERGER AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4236
Mailing Address - Country:US
Mailing Address - Phone:858-279-4879
Mailing Address - Fax:858-279-1701
Practice Address - Street 1:3131 BERGER AVE STE 250
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4236
Practice Address - Country:US
Practice Address - Phone:858-279-4879
Practice Address - Fax:858-279-1701
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32798106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist