Provider Demographics
NPI:1942690359
Name:GACHOMO, OLIVIA CHINENYE (PMHMP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:CHINENYE
Last Name:GACHOMO
Suffix:
Gender:F
Credentials:PMHMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3724 EXECUTIVE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1646
Mailing Address - Country:US
Mailing Address - Phone:512-452-2100
Mailing Address - Fax:855-346-7410
Practice Address - Street 1:3724 EXECUTIVE CENTER DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1646
Practice Address - Country:US
Practice Address - Phone:512-452-2100
Practice Address - Fax:855-346-7410
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-24
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127309363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2020130222OtherANCC