Provider Demographics
NPI:1871147579
Name:POLACHEK, JOEL ROBERT (MFT)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:ROBERT
Last Name:POLACHEK
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S BEVERLY DR STE 412
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4807
Mailing Address - Country:US
Mailing Address - Phone:310-435-8754
Mailing Address - Fax:
Practice Address - Street 1:300 S BEVERLY DR STE 412
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4807
Practice Address - Country:US
Practice Address - Phone:310-435-8754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109146106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist