Provider Demographics
NPI:1578074621
Name:BREWER, JOSHUA DALE
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DALE
Last Name:BREWER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:OSCODA
Mailing Address - State:MI
Mailing Address - Zip Code:48750-1413
Mailing Address - Country:US
Mailing Address - Phone:989-254-9902
Mailing Address - Fax:
Practice Address - Street 1:206 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:OSCODA
Practice Address - State:MI
Practice Address - Zip Code:48750-1413
Practice Address - Country:US
Practice Address - Phone:989-254-9902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty