Provider Demographics
NPI:1235798968
Name:MINNICH, JOSHUA (LPC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:MINNICH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4248 OLD COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-8880
Mailing Address - Country:US
Mailing Address - Phone:937-215-7581
Mailing Address - Fax:
Practice Address - Street 1:6601 CENTERVILLE BUSINESS PKWY STE 310
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-2691
Practice Address - Country:US
Practice Address - Phone:937-637-6735
Practice Address - Fax:937-963-0961
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1300579101YM0800X
OHE.1901369101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health