Provider Demographics
NPI:1598125197
Name:BELKA, JOSHUA TYLER
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:TYLER
Last Name:BELKA
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 1:19 CUSHMAN ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7205
Mailing Address - Country:US
Mailing Address - Phone:207-242-7745
Mailing Address - Fax:
Practice Address - Street 1:19 CUSHMAN ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7205
Practice Address - Country:US
Practice Address - Phone:207-242-7745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4640101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional