MEDICARE: JOSHUA JAMES KIMBALL LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	142838	CA

General Provider Information

NPI Number	:	1619523552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA JAMES KIMBALL LMFT

Provider Business Mailing Address
First Line	:	872 CAYO GRANDE CT
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91320-1943
Country	:	US
Telephone Number	:	661-375-7766
Fax Number	:

Provider Business Practice Location Address
First Line	:	11145 TAMPA AVE STE 23A
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-2271
Country	:	US
Telephone Number	:	661-375-7766
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2019
Last Update Date	:	01/11/2024

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