Provider Demographics
NPI:1841486081
Name:CANTU, JOE XAVIER (MFT)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:XAVIER
Last Name:CANTU
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10436 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 3050
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-226-2994
Mailing Address - Fax:
Practice Address - Street 1:10436 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 3050
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6933
Practice Address - Country:US
Practice Address - Phone:310-226-2994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44906106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist