Provider Demographics
NPI:1578831103
Name:JONATHAN, NAVEEN (PHD, LMFT)
Entity Type:Individual
Prefix:MR
First Name:NAVEEN
Middle Name:
Last Name:JONATHAN
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 BELLECOUR WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-7931
Mailing Address - Country:US
Mailing Address - Phone:909-648-6493
Mailing Address - Fax:
Practice Address - Street 1:921 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3501
Practice Address - Country:US
Practice Address - Phone:714-709-4708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-10
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46703106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist