Healthcare Provider Details

I. General information

NPI: 1124738034
Provider Name (Legal Business Name): JOSHUA MARSHALL LICENSED CLINICAL SOCIAL WORKER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41945 BIG BEAR BLVD # 208
BIG BEAR LAKE CA
92315-2030
US

IV. Provider business mailing address

217 CRIMSON CIR
BIG BEAR CITY CA
92314-9200
US

V. Phone/Fax

Practice location:
  • Phone: 909-351-0743
  • Fax:
Mailing address:
  • Phone: 949-892-9279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSHUA JAMES MARSHALL
Title or Position: CEO
Credential: LCSW
Phone: 949-892-9279