Provider Demographics
NPI:1154073377
Name:JOY, MATTHEW OWEN
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:OWEN
Last Name:JOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26140 NAUMANN AVE
Mailing Address - Street 2:
Mailing Address - City:HOMELAND
Mailing Address - State:CA
Mailing Address - Zip Code:92548-9720
Mailing Address - Country:US
Mailing Address - Phone:951-973-4746
Mailing Address - Fax:
Practice Address - Street 1:27990 SHERMAN RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92585-9155
Practice Address - Country:US
Practice Address - Phone:951-309-9135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty