Provider Demographics
NPI:1427519941
Name:POLLOCK, JOE MAC JR (AMFT)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:MAC
Last Name:POLLOCK
Suffix:JR
Gender:M
Credentials:AMFT
Other - Prefix:MR
Other - First Name:JOE
Other - Middle Name:MAC
Other - Last Name:POLLOCK
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:JOE M POLLOCK JR
Mailing Address - Street 1:4164 BROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3400
Mailing Address - Country:US
Mailing Address - Phone:951-683-5193
Mailing Address - Fax:
Practice Address - Street 1:4164 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3400
Practice Address - Country:US
Practice Address - Phone:951-683-5193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA108787106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health