Provider Demographics
NPI:1245515683
Name:DAMBARA, JOSHUA
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:DAMBARA
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 1:217 E 300 S
Mailing Address - Street 2:SUITE 207
Mailing Address - City:KANAB
Mailing Address - State:UT
Mailing Address - Zip Code:84741-3608
Mailing Address - Country:US
Mailing Address - Phone:424-353-3265
Mailing Address - Fax:435-644-5097
Practice Address - Street 1:217 E 300 S
Practice Address - Street 2:SUITE 207
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741-3608
Practice Address - Country:US
Practice Address - Phone:424-353-3265
Practice Address - Fax:435-644-5097
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8059761-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist