Provider Demographics
NPI:1881805661
Name:MAXWELL, JOANNA FOX (LMFT)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:FOX
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:FOX
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1931 VISTA MAR DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-3747
Mailing Address - Country:US
Mailing Address - Phone:530-400-6186
Mailing Address - Fax:
Practice Address - Street 1:732 3RD ST STE A
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4595
Practice Address - Country:US
Practice Address - Phone:530-400-6186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34109106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist