Provider Demographics
NPI:1194975185
Name:KURTH, JOSHUA D (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:D
Last Name:KURTH
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 LRC RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-6557
Mailing Address - Country:US
Mailing Address - Phone:314-637-7443
Mailing Address - Fax:
Practice Address - Street 1:102 W MILL ST UNIT 6A
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1917
Practice Address - Country:US
Practice Address - Phone:314-399-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007011891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1194975185Medicaid