Provider Demographics
NPI:1861698599
Name:KARBER, JONATHAN BRADLEY (LMFT)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:BRADLEY
Last Name:KARBER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5877 PEARL OYSTER LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-7563
Mailing Address - Country:US
Mailing Address - Phone:817-320-4619
Mailing Address - Fax:817-306-7523
Practice Address - Street 1:4686 BRISTOL TRACE TRL
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-6947
Practice Address - Country:US
Practice Address - Phone:817-300-1590
Practice Address - Fax:817-886-0504
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61895101YP2500X
TX200875106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1844409-01Medicaid