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General NPI Number Information
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NPI Number | 1386159705
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Entity Type | Individual
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Provider Name | JOHN A MADDOUX PHD
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Gender | Male
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Dates
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Enumeration Date | 12/07/2017
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 4100 E PIEDRAS DR STE 165
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City | SAN ANTONIO
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State | TX
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Zip | 78228-2502
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Country | US
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Telephone | 210-705-5060
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Fax |
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Provider Business Mailing Address
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Address Line | 7901 METROPOLIS DR
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City | AUSTIN
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State | TX
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Zip | 78744-3111
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Country | US
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Telephone | 512-739-7332
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2017042123
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 37699
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License Number State | TX
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