Provider Demographics
NPI:1497498083
Name:MCCALL, JOHNNY (BCPC, LCDC, LPC-A)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:MCCALL
Suffix:
Gender:M
Credentials:BCPC, LCDC, LPC-A
Other - Prefix:MR
Other - First Name:JB
Other - Middle Name:
Other - Last Name:MCCALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCPC, LCDC, LPC-A
Mailing Address - Street 1:2304 BARDIN RD STE 202
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3855
Mailing Address - Country:US
Mailing Address - Phone:972-236-7484
Mailing Address - Fax:682-292-2402
Practice Address - Street 1:2304 BARDIN RD STE 202
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3855
Practice Address - Country:US
Practice Address - Phone:972-236-7484
Practice Address - Fax:682-292-2402
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16065101YA0400X
101YP1600X
TX87594101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral