Provider Demographics
NPI:1902228992
Name:MEDLEY, JOSHUA ALAN (LPC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ALAN
Last Name:MEDLEY
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 1:1219 COMMERCE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2604
Mailing Address - Country:US
Mailing Address - Phone:870-232-4273
Mailing Address - Fax:870-345-1310
Practice Address - Street 1:1219 COMMERCE DR STE 3
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2604
Practice Address - Country:US
Practice Address - Phone:870-232-4273
Practice Address - Fax:870-345-1310
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1906070101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional