Provider Demographics
NPI:1790062438
Name:MEARS, JOSHUA TIMOTHY (LP)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:TIMOTHY
Last Name:MEARS
Suffix:
Gender:
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10567 165TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-3523
Mailing Address - Country:US
Mailing Address - Phone:957-767-9374
Mailing Address - Fax:855-538-0663
Practice Address - Street 1:10567 165TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-3523
Practice Address - Country:US
Practice Address - Phone:952-767-9374
Practice Address - Fax:855-538-0663
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5553103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1790062438Medicaid