Provider Demographics
NPI:1588094577
Name:ANNA, JOSHUA (BCBA)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:ANNA
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 WHIPPOORWILL RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1040
Mailing Address - Country:US
Mailing Address - Phone:502-777-2397
Mailing Address - Fax:
Practice Address - Street 1:1601 WHIPPOORWILL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1040
Practice Address - Country:US
Practice Address - Phone:502-777-2397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst