Provider Demographics
NPI:1508224502
Name:HOTALING, JOSHUA (MA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:HOTALING
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 1:7081 POWLESLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-1420
Mailing Address - Country:US
Mailing Address - Phone:419-708-7117
Mailing Address - Fax:
Practice Address - Street 1:7081 POWLESLAND AVE
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-1420
Practice Address - Country:US
Practice Address - Phone:419-708-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015274101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional