Provider Demographics
NPI:1386159705
Name:MADDOUX, JOHN A (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:MADDOUX
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 METROPOLIS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-3111
Mailing Address - Country:US
Mailing Address - Phone:512-739-7332
Mailing Address - Fax:
Practice Address - Street 1:4100 E PIEDRAS DR STE 165
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-2502
Practice Address - Country:US
Practice Address - Phone:210-705-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017042123103T00000X
TX37699103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist