Provider Demographics
NPI:1770709826
Name:RAPHAEL, JOE CHRISTIAN (MFTI MACLP)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:CHRISTIAN
Last Name:RAPHAEL
Suffix:
Gender:M
Credentials:MFTI MACLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 S FAIRMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1336
Mailing Address - Country:US
Mailing Address - Phone:714-998-3272
Mailing Address - Fax:
Practice Address - Street 1:160 S FAIRMONT BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1336
Practice Address - Country:US
Practice Address - Phone:714-998-3272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44338106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist