Provider Demographics
NPI:1447570197
Name:STATT, JONATHAN S (LMFT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:S
Last Name:STATT
Suffix:
Gender:M
Credentials: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 89784
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85752-9784
Mailing Address - Country:US
Mailing Address - Phone:520-447-7440
Mailing Address - Fax:520-306-4861
Practice Address - Street 1:1022 W INA RD # 103
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3109
Practice Address - Country:US
Practice Address - Phone:520-447-7440
Practice Address - Fax:520-306-4861
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-10409106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ869846Medicaid