Provider Demographics
NPI:1326718990
Name:GOTLIB, JOSHUA ANDREW (MS, LPC, CADC III)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:ANDREW
Last Name:GOTLIB
Suffix:
Gender:M
Credentials:MS, LPC, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 MILLRACE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-2536
Mailing Address - Country:US
Mailing Address - Phone:541-357-9433
Mailing Address - Fax:
Practice Address - Street 1:132 E BROADWAY STE 730
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3160
Practice Address - Country:US
Practice Address - Phone:541-357-9433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC6273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500826657Medicaid