Provider Demographics
NPI:1427539162
Name:NOVAK, JOSH ROBERT (LMFT)
Entity type:Individual
Prefix:DR
First Name:JOSH
Middle Name:ROBERT
Last Name:NOVAK
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 S 670 W
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-5711
Mailing Address - Country:US
Mailing Address - Phone:219-798-7642
Mailing Address - Fax:
Practice Address - Street 1:186 E 1800 N
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2019
Practice Address - Country:US
Practice Address - Phone:435-994-8219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8978978-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist