Healthcare Provider Details

I. General information

NPI: 1770914400
Provider Name (Legal Business Name): JOSHUA SAGE KENDRICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2013
Last Update Date: 11/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E MICHELTORENA ST
SANTA BARBARA CA
93101-1905
US

IV. Provider business mailing address

107 E MICHELTORENA ST
SANTA BARBARA CA
93101-1905
US

V. Phone/Fax

Practice location:
  • Phone: 805-965-3434
  • Fax:
Mailing address:
  • Phone: 805-965-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF83736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: