MEDICARE: MR. JOHN RUSSELL RANGEL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	50092	TX

General Provider Information

NPI Number	:	1316170731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN RUSSELL RANGEL LCSW

Provider Business Mailing Address
First Line	:	1931 NW MILITARY HWY
Second Line	:	SUITE #222
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2153
Country	:	US
Telephone Number	:	210-349-7404
Fax Number	:	210-344-2607

Provider Business Practice Location Address
First Line	:	1931 NW MILITARY HWY
Second Line	:	SUITE #222
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2153
Country	:	US
Telephone Number	:	210-349-7404
Fax Number	:	210-344-2607

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2009
Last Update Date	:	11/28/2011

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