Provider Demographics
NPI:1326669375
Name:JOY, JOAN (MA)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:JOY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JOANIE
Other - Middle Name:
Other - Last Name:JOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1322 E SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7918
Mailing Address - Country:US
Mailing Address - Phone:559-439-5920
Mailing Address - Fax:
Practice Address - Street 1:1322 E SHAW AVE STE 410
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7904
Practice Address - Country:US
Practice Address - Phone:559-226-1316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA119573106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty