Provider Demographics
NPI:1316170731
Name:RANGEL, JOHN RUSSELL (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RUSSELL
Last Name:RANGEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1931 NW MILITARY HWY
Mailing Address - Street 2:SUITE #222
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2153
Mailing Address - Country:US
Mailing Address - Phone:210-349-7404
Mailing Address - Fax:210-344-2607
Practice Address - Street 1:1931 NW MILITARY HWY
Practice Address - Street 2:SUITE #222
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2153
Practice Address - Country:US
Practice Address - Phone:210-349-7404
Practice Address - Fax:210-344-2607
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX500921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical