Provider Demographics
NPI:1073119368
Name:JOSLYN, AMBER (CO 61083627)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:JOSLYN
Suffix:
Gender:F
Credentials:CO 61083627
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16831 N 58TH ST APT 145
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1258
Mailing Address - Country:US
Mailing Address - Phone:360-927-3460
Mailing Address - Fax:
Practice Address - Street 1:4041 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-3330
Practice Address - Country:US
Practice Address - Phone:602-279-5262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLASAC-15435101YA0400X
WACO61083627101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)