Provider Demographics
NPI:1013705078
Name:EDMOND, JOSIAH JEMORE
Entity type:Individual
Prefix:
First Name:JOSIAH
Middle Name:JEMORE
Last Name:EDMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 W DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-7609
Mailing Address - Country:US
Mailing Address - Phone:559-649-7107
Mailing Address - Fax:
Practice Address - Street 1:448 W DIAMOND ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-7609
Practice Address - Country:US
Practice Address - Phone:559-649-7107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician