Healthcare Provider Details

I. General information

NPI: 1902303209
Provider Name (Legal Business Name): MADISON JOELLE CAMBRA MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 OREGON ST STE 216
REDDING CA
96001-1757
US

IV. Provider business mailing address

1650 OREGON ST STE 216
REDDING CA
96001-1757
US

V. Phone/Fax

Practice location:
  • Phone: 530-206-5560
  • Fax: 530-206-5556
Mailing address:
  • Phone: 530-206-5560
  • Fax: 530-206-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number133188
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: