Provider Demographics
NPI:1578833190
Name:PAPPAS, JONATHAN (LMFT 90331)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:PAPPAS
Suffix:
Gender:M
Credentials:LMFT 90331
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E THOUSAND OAKS BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-8132
Mailing Address - Country:US
Mailing Address - Phone:805-320-5712
Mailing Address - Fax:
Practice Address - Street 1:100 E THOUSAND OAKS BLVD STE 225
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8132
Practice Address - Country:US
Practice Address - Phone:805-320-5712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CALMFT 90331106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty