Healthcare Provider Details

I. General information

NPI: 1669062790
Provider Name (Legal Business Name): JOSHUA BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E MAIN ST
STOCKTON CA
95202-3032
US

IV. Provider business mailing address

401 E MAIN ST
STOCKTON CA
95202-3032
US

V. Phone/Fax

Practice location:
  • Phone: 209-870-0471
  • Fax:
Mailing address:
  • Phone: 209-870-0471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4964
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number4964
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: