MEDICARE: JOHNNY WORLEY PH.D.

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	103T00000X	Psychologist	21008	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7233353	OTHER	TX	AETNA BEHAVIORAL HEALTH
3	5648810	OTHER	TX	FIRST HEALTH/CCN
4	109022	OTHER	TX	SUPERIOR
5	257054	OTHER	TX	COMPSYCH
6	00249P	OTHER	TX	BLUE CROSS BLUE SHIELD
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811996085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNNY WORLEY PH.D.

Provider Business Mailing Address
First Line	:	1808 ROSE STREET
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-4219
Country	:	US
Telephone Number	:	940-322-2372
Fax Number	:	940-322-3578

Provider Business Practice Location Address
First Line	:	1800 ROSE ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-4219
Country	:	US
Telephone Number	:	940-322-2372
Fax Number	:	940-322-3578

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/09/2007

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Directions to “ JOHNNY WORLEY PH.D.” Practice Location

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