Healthcare Provider Details

I. General information

NPI: 1851893853
Provider Name (Legal Business Name): ACHIEVE CONNECTION COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 MEDICAL PKWY STE 320
CEDAR PARK TX
78613-7904
US

IV. Provider business mailing address

1002 COCKRILL CT
HUTTO TX
78634-4504
US

V. Phone/Fax

Practice location:
  • Phone: 713-540-2301
  • Fax:
Mailing address:
  • Phone: 713-540-2301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number73326
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number202446
License Number StateTX

VIII. Authorized Official

Name: NICOLE GRIFFITH
Title or Position: OWNER
Credential: LPC, LMFT
Phone: 713-540-2301