Provider Demographics
NPI:1316542699
Name:MANSON, JOSHUA DAVID
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAVID
Last Name:MANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 N CANTON CENTER RD STE 270
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2614
Mailing Address - Country:US
Mailing Address - Phone:269-569-5957
Mailing Address - Fax:
Practice Address - Street 1:5840 N CANTON CENTER RD STE 270
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2614
Practice Address - Country:US
Practice Address - Phone:269-569-5957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst