Provider Demographics
NPI:1497126304
Name:SMITH, JONATHAN (LMFT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:SMITH
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 1:444 N LARCHMONT BLVD
Mailing Address - Street 2:109
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3000
Mailing Address - Country:US
Mailing Address - Phone:310-717-3678
Mailing Address - Fax:
Practice Address - Street 1:444 N LARCHMONT BLVD
Practice Address - Street 2:109
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3000
Practice Address - Country:US
Practice Address - Phone:310-717-3678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86787106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist