Provider Demographics
NPI:1689710709
Name:JOE M JEFFERS
Entity Type:Organization
Organization Name:JOE M JEFFERS
Other - Org Name:WEST TEXAS PSYCHOLOGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JEFFERS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:325-942-7531
Mailing Address - Street 1:3471 KNICKERBOCKER RD
Mailing Address - Street 2:SUITE 508
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-8823
Mailing Address - Country:US
Mailing Address - Phone:325-942-7531
Mailing Address - Fax:325-942-7532
Practice Address - Street 1:3471 KNICKERBOCKER RD
Practice Address - Street 2:SUITE 508
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-8823
Practice Address - Country:US
Practice Address - Phone:325-942-7531
Practice Address - Fax:325-942-7532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12487101YM0800X
TX13927101YP2500X
TX21733103TC1900X
TX067741041C0700X
TX241631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084966301Medicaid
TX084966301Medicaid