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General NPI Number Information
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NPI Number | 1609810092
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Entity Type | Individual
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Provider Name | JOHN ROBERT SKINNER JR. PHD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 02/19/2010
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Provider Practice Location Address
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Address Line | 508 GRACE ST
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City | WAXAHACHIE
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State | TX
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Zip | 75165-3046
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Country | US
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Telephone | 714-536-2570
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Fax | 972-709-5786
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Provider Business Mailing Address
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Address Line | 307 SHOREWOOD DR
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City | DUNCANVILLE
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State | TX
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Zip | 75116-3632
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Country | US
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Telephone | 972-298-8701
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Fax | 972-709-5786
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2-3650
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License Number State | TX
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