Provider Demographics
NPI:1831874858
Name:KOHANSAMAD, JOSHUA (AMFT, APCC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:KOHANSAMAD
Suffix:
Gender:M
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BUTTERFLY LN
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-2444
Mailing Address - Country:US
Mailing Address - Phone:805-364-1566
Mailing Address - Fax:
Practice Address - Street 1:205 AVENIDA DEL NORTE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5702
Practice Address - Country:US
Practice Address - Phone:213-218-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health