Provider Demographics
NPI:1538558648
Name:MOHR, JOHN DARRELL (PHD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DARRELL
Last Name:MOHR
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 1:2251 CENTRAL DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-2811
Mailing Address - Country:US
Mailing Address - Phone:409-880-8065
Mailing Address - Fax:
Practice Address - Street 1:4400 MLK BLVD
Practice Address - Street 2:EDUCATION BLDG, RM 115
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77710
Practice Address - Country:US
Practice Address - Phone:409-880-8065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty