Healthcare Provider Details

I. General information

NPI: 1144836099
Provider Name (Legal Business Name): JOSHUA A. LEDERACH M.A, AMFT, APCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/16/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 CASS ST # C
MONTEREY CA
93940-4515
US

IV. Provider business mailing address

214 MAIN ST APT 260
EL SEGUNDO CA
90245-3803
US

V. Phone/Fax

Practice location:
  • Phone: 831-996-1222
  • Fax:
Mailing address:
  • Phone: 720-560-2602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: