Provider Demographics
NPI:1285829382
Name:STIANSEN, JONATHAN (MS, LMFT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:STIANSEN
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2782
Mailing Address - Street 2:
Mailing Address - City:RUNNING SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92382-2782
Mailing Address - Country:US
Mailing Address - Phone:909-261-5235
Mailing Address - Fax:909-383-3212
Practice Address - Street 1:799 E RIALTO AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-1005
Practice Address - Country:US
Practice Address - Phone:909-383-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 48446106H00000X
CAMFC45365106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist