Provider Demographics
NPI:1265909931
Name:WELLSTED, JOSH WELLSTED
Entity type:Individual
Prefix:
First Name:JOSH
Middle Name:WELLSTED
Last Name:WELLSTED
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 1:5461 AGOSTINO CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-2423
Mailing Address - Country:US
Mailing Address - Phone:925-673-8912
Mailing Address - Fax:
Practice Address - Street 1:5461 AGOSTINO CT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-2423
Practice Address - Country:US
Practice Address - Phone:925-673-8912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-19-79665106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician