Provider Demographics
NPI:1154609519
Name:POPKIN, JOSHUA (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:POPKIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 CRESTLINE CIR
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-2206
Mailing Address - Country:US
Mailing Address - Phone:940-367-2907
Mailing Address - Fax:307-257-2134
Practice Address - Street 1:3412 CRESTLINE CIR
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-2206
Practice Address - Country:US
Practice Address - Phone:940-367-2907
Practice Address - Fax:307-257-2134
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2016-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY576103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist