Provider Demographics
NPI:1962529982
Name:LANDON, JOAN MCMULLEN
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:MCMULLEN
Last Name:LANDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 WILLIAMS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2665
Mailing Address - Country:US
Mailing Address - Phone:805-981-4200
Mailing Address - Fax:
Practice Address - Street 1:1911 WILLIAMS DR STE 110
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2665
Practice Address - Country:US
Practice Address - Phone:805-981-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35093106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist