Provider Demographics
NPI:1093953226
Name:EMERY, JOSHUA JEROME (MA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JEROME
Last Name:EMERY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 E MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3105
Mailing Address - Country:US
Mailing Address - Phone:970-490-1309
Mailing Address - Fax:970-490-8940
Practice Address - Street 1:803 E MULBERRY ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3105
Practice Address - Country:US
Practice Address - Phone:970-490-1309
Practice Address - Fax:970-490-8940
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4710101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health