Provider Demographics
NPI:1356895429
Name:WOODARD, JONATHAN (LMFT #123611)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:WOODARD
Suffix:
Gender:M
Credentials:LMFT #123611
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 E SHAW AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7708
Mailing Address - Country:US
Mailing Address - Phone:559-691-6840
Mailing Address - Fax:
Practice Address - Street 1:770 E SHAW AVE STE 230
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7708
Practice Address - Country:US
Practice Address - Phone:559-691-6840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-06
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123611101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health