Provider Demographics
NPI:1235662990
Name:DAVIS, JOSHUA
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:DAVIS
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:PO BOX 680
Mailing Address - Street 2:
Mailing Address - City:LAKE HUGHES
Mailing Address - State:CA
Mailing Address - Zip Code:93532-0680
Mailing Address - Country:US
Mailing Address - Phone:661-400-7599
Mailing Address - Fax:
Practice Address - Street 1:38215 SAN FRANCISQUITO CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91390-4914
Practice Address - Country:US
Practice Address - Phone:661-270-0025
Practice Address - Fax:661-270-1341
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-09
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1233901016101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)