Provider Demographics
NPI:1124738034
Name:JOSHUA MARSHALL LICENSED CLINICAL SOCIAL WORKER INC.
Entity type:Organization
Organization Name:JOSHUA MARSHALL LICENSED CLINICAL SOCIAL WORKER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:949-892-9279
Mailing Address - Street 1:217 CRIMSON CIR
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92314-9200
Mailing Address - Country:US
Mailing Address - Phone:949-892-9279
Mailing Address - Fax:
Practice Address - Street 1:41945 BIG BEAR BLVD # 208
Practice Address - Street 2:
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315-2030
Practice Address - Country:US
Practice Address - Phone:909-351-0743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)