Healthcare Provider Details

I. General information

NPI: 1497096580
Provider Name (Legal Business Name): JOSHUA W TREADWAY LPCC-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 WOODMAN DR STE 330
DAYTON OH
45432-1410
US

IV. Provider business mailing address

1810 AMBRIDGE RD
CENTERVILLE OH
45459-5108
US

V. Phone/Fax

Practice location:
  • Phone: 937-253-0606
  • Fax:
Mailing address:
  • Phone: 937-430-4851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1100100-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: