MEDICARE: JOHNYALE MCDANIEL

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1790191922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNYALE MCDANIEL

Provider Business Mailing Address
First Line	:	PO BOX 20533
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77225-0533
Country	:	US
Telephone Number	:	832-205-1628
Fax Number	:	281-257-9068

Provider Business Practice Location Address
First Line	:	2626 S LOOP W STE 650A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-5628
Country	:	US
Telephone Number	:	832-205-1628
Fax Number	:

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

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	05/16/2020

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Directions to “ JOHNYALE MCDANIEL ” Practice Location

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