Provider Demographics
NPI:1144836099
Name:LEDERACH, JOSHUA A (MA, AMFT, APCC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:A
Last Name:LEDERACH
Suffix:
Gender:M
Credentials:MA, AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 MAIN ST APT 260
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3803
Mailing Address - Country:US
Mailing Address - Phone:720-560-2602
Mailing Address - Fax:
Practice Address - Street 1:1010 CASS ST # C
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4515
Practice Address - Country:US
Practice Address - Phone:831-996-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119574106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist