Provider Demographics
NPI:1134952898
Name:WELBORN, JOSHUA ROBERT
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ROBERT
Last Name:WELBORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9293 PR 3350
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75645-7616
Mailing Address - Country:US
Mailing Address - Phone:903-331-6159
Mailing Address - Fax:
Practice Address - Street 1:9293 PR 3350
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75645-7616
Practice Address - Country:US
Practice Address - Phone:903-331-6159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician