Provider Demographics
NPI:1851863450
Name:KREBS, JOSHUA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:KREBS
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:
Other - Last Name:KREBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:575 S ROYAL ST STE 24
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-7307
Mailing Address - Country:US
Mailing Address - Phone:731-215-0502
Mailing Address - Fax:
Practice Address - Street 1:575 S ROYAL ST STE 24
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-7307
Practice Address - Country:US
Practice Address - Phone:731-215-0502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4511101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ049885Medicaid