Provider Demographics
NPI:1639042609
Name:AIDOO, JOHN KOFI SR
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KOFI
Last Name:AIDOO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:LATONYA
Other - Middle Name:SANTAGO
Other - Last Name:AIDOO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR
Mailing Address - Street 1:849 RUTHERFORD DR
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-2711
Mailing Address - Country:US
Mailing Address - Phone:682-241-0819
Mailing Address - Fax:
Practice Address - Street 1:849 RUTHERFORD DR
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-2711
Practice Address - Country:US
Practice Address - Phone:682-241-0819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46-1781757101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty