Healthcare Provider Details

I. General information

NPI: 1508224502
Provider Name (Legal Business Name): JOSHUA HOTALING M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7081 POWLESLAND AVE
TEMPERANCE MI
48182-1420
US

IV. Provider business mailing address

7081 POWLESLAND AVE
TEMPERANCE MI
48182-1420
US

V. Phone/Fax

Practice location:
  • Phone: 419-708-7117
  • Fax:
Mailing address:
  • Phone: 419-708-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015274
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: