Healthcare Provider Details

I. General information

NPI: 1871020040
Provider Name (Legal Business Name): JOSHUA SCOTT ANTLES LMHC, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 07/21/2022
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10410 E 9TH AVE
SPOKANE VALLEY WA
99206-3510
US

IV. Provider business mailing address

6103 W WINDRIVER DR
SPOKANE WA
99208-9018
US

V. Phone/Fax

Practice location:
  • Phone: 509-321-9050
  • Fax:
Mailing address:
  • Phone: 509-979-4790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61124921
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLH60460265
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60460265
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: