Provider Demographics
NPI:1770645673
Name:MINDEN, JOEL ALLEN (PHD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:ALLEN
Last Name:MINDEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 BROADWAY ST
Mailing Address - Street 2:STE 414
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5342
Mailing Address - Country:US
Mailing Address - Phone:530-690-5635
Mailing Address - Fax:
Practice Address - Street 1:341 BROADWAY ST
Practice Address - Street 2:STE 414
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5342
Practice Address - Country:US
Practice Address - Phone:530-690-5635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2017-02-10
Deactivation Date:2013-02-19
Deactivation Code:
Reactivation Date:2016-02-18
Provider Licenses
StateLicense IDTaxonomies
CAPSY27859103TC0700X
103TE1100X, 103TC1900X, 103TB0200X
CA27859103TC0700X, 103TB0200X, 103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral