Healthcare Provider Details

I. General information

NPI: 1821817248
Provider Name (Legal Business Name): JOSHUA DAVID ROBERTS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 E JACKSON ST
MEDFORD OR
97504-7027
US

IV. Provider business mailing address

2949 FAIRFAX ST
MEDFORD OR
97504-5816
US

V. Phone/Fax

Practice location:
  • Phone: 503-812-7435
  • Fax:
Mailing address:
  • Phone: 503-812-7435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT3255
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: