Provider Demographics
NPI:1174081061
Name:NAVARRO, JOE (LMFT)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:NAVARRO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12246 HIGHGATE CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-9147
Mailing Address - Country:US
Mailing Address - Phone:909-276-9182
Mailing Address - Fax:
Practice Address - Street 1:10630 TOWN CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6806
Practice Address - Country:US
Practice Address - Phone:909-989-0901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-09
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT38651106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist