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General NPI Number Information
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NPI Number | 1083020754
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Entity Type | Individual
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Provider Name | JOHN TYLER HARRELL M.S.
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Gender | Male
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Dates
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Enumeration Date | 07/02/2014
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 3301 S 14TH ST SUITE 16 PMB 125
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City | ABILENE
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State | TX
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Zip | 79605-5015
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Country | US
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Telephone | 325-455-0252
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Fax |
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Provider Business Mailing Address
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Address Line | 1726 WOODRIDGE DR
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City | ABILENE
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State | TX
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Zip | 79605-4830
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Country | US
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Telephone | 325-665-6533
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 12457
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 67073
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License Number State | TX
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