Provider Demographics
NPI:1043638430
Name:CROCKER, JOSHUA MCLEOD (LMFT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MCLEOD
Last Name:CROCKER
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 1:1650 OREGON ST STE 210
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1757
Mailing Address - Country:US
Mailing Address - Phone:530-395-4777
Mailing Address - Fax:530-243-3391
Practice Address - Street 1:1650 OREGON ST STE 210
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1757
Practice Address - Country:US
Practice Address - Phone:530-395-4777
Practice Address - Fax:530-243-3391
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health