Provider Demographics
NPI:1053912477
Name:ACACIA PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:ACACIA PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGGINBOTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:888-699-4873
Mailing Address - Street 1:281 MAGNOLIA AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-3608
Mailing Address - Country:US
Mailing Address - Phone:888-699-4873
Mailing Address - Fax:805-472-6099
Practice Address - Street 1:5900 BALCONES DR STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4298
Practice Address - Country:US
Practice Address - Phone:888-699-4873
Practice Address - Fax:805-472-6099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty