Provider Demographics
NPI:1215077821
Name:ONEAL, JON BRIAN (MFT)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:BRIAN
Last Name:ONEAL
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5403 FACULTY AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1845
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17315 STUDEBAKER RD
Practice Address - Street 2:SUITE 130
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2563
Practice Address - Country:US
Practice Address - Phone:562-924-1277
Practice Address - Fax:562-860-6283
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC-20277106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist