1811996085 NPI number — JOHNNY WORLEY PH.D.

Table of content: JOHNNY WORLEY PH.D. (NPI 1811996085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811996085 NPI number — JOHNNY WORLEY PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WORLEY
Provider First Name:
JOHNNY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811996085
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1808 ROSE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA FALLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76301-4219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-322-2372
Provider Business Mailing Address Fax Number:
940-322-3578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 ROSE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA FALLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76301-4219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-322-2372
Provider Business Practice Location Address Fax Number:
940-322-3578
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  21008 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100369104 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7233353 . This is a "AETNA BEHAVIORAL HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5648810 . This is a "FIRST HEALTH/CCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 109022 . This is a "SUPERIOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 257054 . This is a "COMPSYCH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00249P . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 200065410A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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