Provider Demographics
NPI:1811996085
Name:WORLEY, JOHNNY (PHD)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:WORLEY
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 1:1808 ROSE STREET
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4219
Mailing Address - Country:US
Mailing Address - Phone:940-322-2372
Mailing Address - Fax:940-322-3578
Practice Address - Street 1:1800 ROSE ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4219
Practice Address - Country:US
Practice Address - Phone:940-322-2372
Practice Address - Fax:940-322-3578
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21008103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100369104Medicaid
TX7233353OtherAETNA BEHAVIORAL HEALTH
TX5648810OtherFIRST HEALTH/CCN
TX109022OtherSUPERIOR
TX257054OtherCOMPSYCH
TX00249POtherBLUE CROSS BLUE SHIELD
OK200065410AMedicaid
OK200065410AMedicaid