Provider Demographics
NPI:1336230606
Name:STRECKER, JEROME JOHN (PHD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:JOHN
Last Name:STRECKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 835
Mailing Address - Street 2:
Mailing Address - City:FRITCH
Mailing Address - State:TX
Mailing Address - Zip Code:79036-0835
Mailing Address - Country:US
Mailing Address - Phone:806-857-2422
Mailing Address - Fax:
Practice Address - Street 1:1008 MEGERT CTR
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-2404
Practice Address - Country:US
Practice Address - Phone:806-274-7313
Practice Address - Fax:806-274-4227
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX458960Medicare PIN