Provider Demographics
NPI:1821459033
Name:BECKETT, JOSHUA (MA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:BECKETT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 WESTWOOD BLVD # 1152
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2109
Mailing Address - Country:US
Mailing Address - Phone:310-737-8025
Mailing Address - Fax:
Practice Address - Street 1:663 LILLIAN WAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-1107
Practice Address - Country:US
Practice Address - Phone:310-737-8025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF84243106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist