Provider Demographics
NPI:1679047443
Name:SPAVIN, JOSHUA (LMFT, RPT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:SPAVIN
Suffix:
Gender:M
Credentials:LMFT, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 N MILLS AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5746
Mailing Address - Country:US
Mailing Address - Phone:321-285-6609
Mailing Address - Fax:
Practice Address - Street 1:430 N MILLS AVE STE 4
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5746
Practice Address - Country:US
Practice Address - Phone:321-285-6609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3531106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist