Provider Demographics
NPI:1194458018
Name:MARBACH, JOSHUA JOHN (PHD, LP, LSSP)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JOHN
Last Name:MARBACH
Suffix:
Gender:M
Credentials:PHD, LP, LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6424 DAKAR RD W
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-1919
Mailing Address - Country:US
Mailing Address - Phone:830-237-5513
Mailing Address - Fax:
Practice Address - Street 1:5920 W WILLIAM CANNON DR STE 222
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1902
Practice Address - Country:US
Practice Address - Phone:512-282-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist