Provider Demographics
NPI:1669017406
Name:WALPOLE, JOSHUA (ACMHC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:WALPOLE
Suffix:
Gender:M
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8478 S 6160 W
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-3338
Mailing Address - Country:US
Mailing Address - Phone:385-237-8131
Mailing Address - Fax:
Practice Address - Street 1:151 E 5600 S
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6181
Practice Address - Country:US
Practice Address - Phone:435-200-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11539032-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health