Provider Demographics
NPI:1891229688
Name:DYER, JOEL
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:DYER
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 1:9240 OLD REDWOOD HWY STE 200-253
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-9348
Mailing Address - Country:US
Mailing Address - Phone:707-328-0801
Mailing Address - Fax:
Practice Address - Street 1:9240 OLD REDWOOD HWY STE 200-253
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-9348
Practice Address - Country:US
Practice Address - Phone:707-328-0801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF94609106H00000X
CALMFT119399106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist