Provider Demographics
NPI:1083020754
Name:HARRELL, JOHN TYLER (MS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TYLER
Last Name:HARRELL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4830
Mailing Address - Country:US
Mailing Address - Phone:325-665-6533
Mailing Address - Fax:
Practice Address - Street 1:3301 S 14TH ST
Practice Address - Street 2:SUITE 16 PMB 125
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-5015
Practice Address - Country:US
Practice Address - Phone:325-455-0252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12457101YA0400X
TX67073101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)