Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YM0800X | Mental Health Counselor | ||
N | 101YP2500X | Professional Counselor | ||
N | 101YS0200X | School Counselor |
NPI | 1104295831 |
---|---|
Provider Name | Dr. Jonathan Hung Ly |
First Address | Whittier, CA 90601-4446 |
Second Address | Whittier, CA 90601-4446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2015 |
Last Update Date | 15/10/2019 |