Healthcare Provider Details

I. General information

NPI: 1629882782
Provider Name (Legal Business Name): JOSIAH PERATONER LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 E AVENIDA PICO SUITE I
SAN CLEMENTE CA
92673
US

IV. Provider business mailing address

806 E AVENIDA PICO SUITE I
SAN CLEMENTE CA
92673
US

V. Phone/Fax

Practice location:
  • Phone: 562-283-8004
  • Fax:
Mailing address:
  • Phone: 562-283-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: