Provider Demographics
NPI:1336146463
Name:ACHACOSO, JOSEPH A (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:ACHACOSO
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W MAIN ST
Mailing Address - Street 2:STE E
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2758
Mailing Address - Country:US
Mailing Address - Phone:512-989-1152
Mailing Address - Fax:512-989-7564
Practice Address - Street 1:104 W MAIN ST
Practice Address - Street 2:STE E
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2758
Practice Address - Country:US
Practice Address - Phone:512-989-1152
Practice Address - Fax:512-989-7564
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19055101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1726655-01Medicaid