Provider Demographics
NPI:1598430787
Name:LICHTMAN, JONATHAN (LMFT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:LICHTMAN
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 1:18237 WEDDINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3619
Mailing Address - Country:US
Mailing Address - Phone:818-590-1919
Mailing Address - Fax:
Practice Address - Street 1:12517 CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-1925
Practice Address - Country:US
Practice Address - Phone:818-798-8273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109004106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist