Healthcare Provider Details

I. General information

NPI: 1265088694
Provider Name (Legal Business Name): JOHN CASEY FRIEDECK AMFT, APCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 S LEWIS RD
CAMARILLO CA
93012-8520
US

IV. Provider business mailing address

1756 S LEWIS RD
CAMARILLO CA
93012-8520
US

V. Phone/Fax

Practice location:
  • Phone: 805-383-3669
  • Fax: 805-383-3692
Mailing address:
  • Phone: 805-383-3669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number111707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: