Provider Demographics
NPI:1952043655
Name:HADDOCK, JOSHUA (MFT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:HADDOCK
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43632 CALABRO ST
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4321
Mailing Address - Country:US
Mailing Address - Phone:310-433-4846
Mailing Address - Fax:
Practice Address - Street 1:43632 CALABRO ST
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4321
Practice Address - Country:US
Practice Address - Phone:310-433-4846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111567106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist