Provider Demographics
NPI:1851914436
Name:CAPPER, JOSHUA KEITH (AMFT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:KEITH
Last Name:CAPPER
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:PO BOX 969
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-1138
Mailing Address - Country:US
Mailing Address - Phone:209-483-8231
Mailing Address - Fax:
Practice Address - Street 1:313 KENDAL ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-3960
Practice Address - Country:US
Practice Address - Phone:707-330-7904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT118425101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health