Provider Demographics
NPI:1881976496
Name:THOMPSON, JOSHUA M (MSED, PC)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MSED, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS PLZ
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1815
Mailing Address - Country:US
Mailing Address - Phone:937-641-3000
Mailing Address - Fax:
Practice Address - Street 1:700 E 1ST ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1303
Practice Address - Country:US
Practice Address - Phone:937-641-3211
Practice Address - Fax:937-641-4660
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1000400-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0186790Medicaid