Provider Demographics
NPI:1538898192
Name:FRISBY, JOSHUA CHARLES
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:CHARLES
Last Name:FRISBY
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 1:3680 PONY TRACKS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-3062
Mailing Address - Country:US
Mailing Address - Phone:719-654-4143
Mailing Address - Fax:
Practice Address - Street 1:3680 PONY TRACKS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-3062
Practice Address - Country:US
Practice Address - Phone:719-654-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
BACB796732106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician