Basic Information
| Provider Information | |||||||||
| NPI: | 1689071300 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLANNES | ||||||||
| FirstName: | JONATHAN | ||||||||
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| Credential: | AMFT, APCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2275 ARLINGTON DR | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945781132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103171444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 750 33RD AVE | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941213428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4159721200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2014 | ||||||||
| LastUpdateDate: | 09/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | AMFT108493 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor |
No ID Information.