Provider Demographics
NPI:1609303031
Name:EASTLICK, JOSHUA (LPC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:EASTLICK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S WATER ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-3626
Mailing Address - Country:US
Mailing Address - Phone:608-348-5088
Mailing Address - Fax:608-348-3302
Practice Address - Street 1:530 S WATER ST STE 3
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818
Practice Address - Country:US
Practice Address - Phone:608-348-5088
Practice Address - Fax:608-348-3302
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7299-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional