Healthcare Provider Details

I. General information

NPI: 1770092108
Provider Name (Legal Business Name): JOHNPAUL NORMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL - BDAACH UNIT #15245, BLDG 3031
APO ARMED FORCES PACIFIC
96271
KR

IV. Provider business mailing address

3263 S GLENHAVEN AVE
SPRINGFIELD MO
65804-4570
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-1219
  • Fax:
Mailing address:
  • Phone: 417-861-7296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC011002
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: