Healthcare Provider Details

I. General information

NPI: 1861315954
Provider Name (Legal Business Name): JOSHUA WILBURN LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 HAIGHT AVE STE 203
POUGHKEEPSIE NY
12603-7205
US

IV. Provider business mailing address

104 ORCHARD AVE
OWEGO NY
13827-1733
US

V. Phone/Fax

Practice location:
  • Phone: 518-245-6272
  • Fax:
Mailing address:
  • Phone: 518-245-6272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number018295
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: