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General NPI Number Information
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NPI Number | 1245952241
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Entity Type | Individual
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Provider Name | JOSHUA DAVID LICHNER
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Gender | Male
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Dates
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Enumeration Date | 09/15/2022
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 901 MAIN ST
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-5810
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Country | US
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Telephone | 541-238-2289
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 ROUND LAKE RD SPC 25
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-9069
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Country | US
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Telephone | 928-533-0667
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | THW000111130
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License Number State | OR
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