Healthcare Provider Details

I. General information

NPI: 1922301167
Provider Name (Legal Business Name): JOSHUA DAVID HARVEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3995 MARCOLA RD
SPRINGFIELD OR
97477-7948
US

IV. Provider business mailing address

260 GREENLEAF AVE
EUGENE OR
97404-2608
US

V. Phone/Fax

Practice location:
  • Phone: 541-726-1465
  • Fax:
Mailing address:
  • Phone: 406-890-1583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: