Provider Demographics
NPI:1518762368
Name:OBADAHUN, JOSEPH S (LICENSEE)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:OBADAHUN
Suffix:
Gender:M
Credentials:LICENSEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13493 JUBILEE PL
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7756
Mailing Address - Country:US
Mailing Address - Phone:909-461-9622
Mailing Address - Fax:
Practice Address - Street 1:13493 JUBILEE PL
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7756
Practice Address - Country:US
Practice Address - Phone:909-461-9622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-20-45161103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty