Provider Demographics
NPI:1508190505
Name:BOSARGE, JOSEPH S (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:BOSARGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 RAE DELL AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4735
Mailing Address - Country:US
Mailing Address - Phone:512-660-1853
Mailing Address - Fax:855-700-9866
Practice Address - Street 1:11238 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78747-1432
Practice Address - Country:US
Practice Address - Phone:512-680-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34161103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical