Provider Demographics
NPI:1235805755
Name:ADAMS, JOHN NELSON (LP PROVISIONAL)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:NELSON
Last Name:ADAMS
Suffix:
Gender:M
Credentials:LP PROVISIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 MEMORIAL HEIGHTS DR APT 9223
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-6061
Mailing Address - Country:US
Mailing Address - Phone:713-621-9515
Mailing Address - Fax:
Practice Address - Street 1:1001 WEST LOOP S STE 215
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-9082
Practice Address - Country:US
Practice Address - Phone:713-621-9515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39061103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling