Provider Demographics
NPI:1881007672
Name:JEFFERSON, JOSEPH ROBERT (PSYD, LP, LMFT, CPRP)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ROBERT
Last Name:JEFFERSON
Suffix:
Gender:M
Credentials:PSYD, LP, LMFT, CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 21ST ST STE R
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-5226
Mailing Address - Country:US
Mailing Address - Phone:619-980-9549
Mailing Address - Fax:
Practice Address - Street 1:4800 OLSON MEMORIAL HWY STE 202
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-5169
Practice Address - Country:US
Practice Address - Phone:507-474-6264
Practice Address - Fax:507-218-8553
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35901103T00000X
MN3198106H00000X
WI1031-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty