Provider Demographics
NPI:1902331234
Name:JOSHUA ROE HAUCK
Entity Type:Organization
Organization Name:JOSHUA ROE HAUCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:ROE
Authorized Official - Last Name:HAUCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCDC
Authorized Official - Phone:281-639-4006
Mailing Address - Street 1:21914 SHAMION CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-1468
Mailing Address - Country:US
Mailing Address - Phone:281-639-4006
Mailing Address - Fax:
Practice Address - Street 1:21914 SHAMION CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-1468
Practice Address - Country:US
Practice Address - Phone:281-639-4006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69394251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX367303002Medicaid
TX367303001Medicaid