Provider Demographics
NPI:1609193994
Name:DRAWHORN, JOSIAH B (PHD, ND, THD)
Entity type:Individual
Prefix:DR
First Name:JOSIAH
Middle Name:B
Last Name:DRAWHORN
Suffix:
Gender:M
Credentials:PHD, ND, THD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 HANCOCK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-5948
Mailing Address - Country:US
Mailing Address - Phone:928-758-8255
Mailing Address - Fax:928-758-4632
Practice Address - Street 1:1225 HANCOCK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5948
Practice Address - Country:US
Practice Address - Phone:928-758-8255
Practice Address - Fax:928-758-4632
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INWAITING 4 TEST DATE103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
BEING SENT TO MEOtherICAADA MEMBER (THIS IS A NEW BUSINESS. WE ARE IN PROCESS OF APPLYING TO ALL