Provider Demographics
NPI:1639685894
Name:SENSENBAUGH, JOSHUA DALE (PSYD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DALE
Last Name:SENSENBAUGH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2273 VIREO DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-6453
Mailing Address - Country:US
Mailing Address - Phone:937-813-9867
Mailing Address - Fax:
Practice Address - Street 1:2601 COMMONS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3830
Practice Address - Country:US
Practice Address - Phone:937-294-6004
Practice Address - Fax:937-294-9053
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OHP.08498103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program