Provider Demographics
NPI:1225670391
Name:JOSEPH, PETER MICHAEL (AMFT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WELCOME LN
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5974
Mailing Address - Country:US
Mailing Address - Phone:562-852-0046
Mailing Address - Fax:
Practice Address - Street 1:2211 E OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-2440
Practice Address - Country:US
Practice Address - Phone:562-434-4060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112781106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA112781OtherMARRIAGE AND FAMILY THERAPY