Provider Demographics
NPI:1689071300
Name:FLANNES, JONATHAN (LMFT #136101)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:FLANNES
Suffix:
Gender:M
Credentials:LMFT #136101
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 N MAR VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1445
Mailing Address - Country:US
Mailing Address - Phone:510-325-8045
Mailing Address - Fax:
Practice Address - Street 1:166 MAR VISTA
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91126-3428
Practice Address - Country:US
Practice Address - Phone:510-325-8045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT108493101YM0800X
106H00000X, 101Y00000X
CA136101106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor