Basic Information
| Provider Information | |||||||||
| NPI: | 1003110420 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PURSIFULL | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S. L.A.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2578 | ||||||||
| Address2: | |||||||||
| City: | BATESVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725032578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707938900 | ||||||||
| FaxNumber: | 8707938959 | ||||||||
| Practice Location | |||||||||
| Address1: | 1716 W SEARCY ST | ||||||||
| Address2: | |||||||||
| City: | HEBER SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725433532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707938900 | ||||||||
| FaxNumber: | 8707938959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2010 | ||||||||
| LastUpdateDate: | 03/18/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A1103025 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.