Provider Demographics
NPI:1245446814
Name:NINOMIYA, JOE JR (MA, MFC, CRC)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:
Last Name:NINOMIYA
Suffix:JR
Gender:M
Credentials:MA, MFC, CRC
Other - Prefix:MR
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:NINOMIYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:PO BOX 82214
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93380-2214
Mailing Address - Country:US
Mailing Address - Phone:559-264-7967
Mailing Address - Fax:
Practice Address - Street 1:5329 OFFICE CENTER CT STE 228
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7419
Practice Address - Country:US
Practice Address - Phone:559-264-7967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24583106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist