Provider Demographics
NPI:1902303209
Name:CAMBRA, MADISON JOELLE (MFT)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:JOELLE
Last Name:CAMBRA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 OREGON ST STE 216
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:530-206-5560
Mailing Address - Fax:530-206-5556
Practice Address - Street 1:1650 OREGON ST STE 216
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:530-206-5560
Practice Address - Fax:530-206-5556
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA133188106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program