Provider Demographics
NPI:1134951932
Name:JAVELLANA, JOSIAH
Entity type:Individual
Prefix:
First Name:JOSIAH
Middle Name:
Last Name:JAVELLANA
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 1:3300 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5628
Mailing Address - Country:US
Mailing Address - Phone:405-810-5200
Mailing Address - Fax:405-493-0700
Practice Address - Street 1:3300 NW 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5628
Practice Address - Country:US
Practice Address - Phone:405-810-5200
Practice Address - Fax:405-493-0700
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist