Provider Demographics
NPI:1689335119
Name:MOLINA, JONATHAN ANTONIO (LMFT-I)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ANTONIO
Last Name:MOLINA
Suffix:
Gender:M
Credentials:LMFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4739 EVERMAN DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-6610
Mailing Address - Country:US
Mailing Address - Phone:702-272-4572
Mailing Address - Fax:
Practice Address - Street 1:4739 EVERMAN DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-6610
Practice Address - Country:US
Practice Address - Phone:702-272-4572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist