Healthcare Provider Details

I. General information

NPI: 1114518016
Provider Name (Legal Business Name): JOSHUA R SISCO LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BOULDER CRESCENT ST STE 201
COLORADO SPRINGS CO
80903-3358
US

IV. Provider business mailing address

10 BOULDER CRESCENT ST STE 201
COLORADO SPRINGS CO
80903-3358
US

V. Phone/Fax

Practice location:
  • Phone: 719-752-2403
  • Fax:
Mailing address:
  • Phone: 719-752-2403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0024555
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: