Provider Demographics
NPI:1609909183
Name:OUSLEY, JONATHAN PAUL (MFTI)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:PAUL
Last Name:OUSLEY
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MIRA MAR AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-2867
Mailing Address - Country:US
Mailing Address - Phone:310-603-1030
Mailing Address - Fax:
Practice Address - Street 1:161 W VICTORIA ST STE 255
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-2178
Practice Address - Country:US
Practice Address - Phone:310-603-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF49316106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist