Provider Demographics
NPI:1053524496
Name:MCLAFFERTY, JOEL (MFT)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:
Last Name:MCLAFFERTY
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 1:1704 W MANCHESTER AVE STE 202A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-3057
Mailing Address - Country:US
Mailing Address - Phone:424-312-2311
Mailing Address - Fax:
Practice Address - Street 1:1704 W MANCHESTER AVE STE 202A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047
Practice Address - Country:US
Practice Address - Phone:424-312-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43113106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11811200OtherCAQH