Provider Demographics
NPI:1578279931
Name:EIBERG, JOSHUA M (MA/MHP, ATR-P)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:M
Last Name:EIBERG
Suffix:
Gender:M
Credentials:MA/MHP, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3459 WASHINGTON DR STE 102
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1388
Mailing Address - Country:US
Mailing Address - Phone:952-913-1776
Mailing Address - Fax:
Practice Address - Street 1:3459 WASHINGTON DR STE 102
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1388
Practice Address - Country:US
Practice Address - Phone:952-913-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21-268101YM0800X, 221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health