MEDICARE: JOSHUA PURSIFULL M.S. L.A.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	A1103025	AR

General Provider Information

NPI Number	:	1003110420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA PURSIFULL M.S. L.A.C.

Provider Business Mailing Address
First Line	:	PO BOX 497
Second Line	:
City	:	AUGUSTA
State	:	AR
Zip	:	72006-0497
Country	:	US
Telephone Number	:	870-347-2534
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 HIGHWAY 62 E
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-2708
Country	:	US
Telephone Number	:	870-970-7140
Fax Number	:	870-701-3181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2010
Last Update Date	:	01/21/2026

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