Provider Demographics
NPI:1780297770
Name:NWEKE, JOHN
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:NWEKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E FM 544 STE 72-261
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4034
Mailing Address - Country:US
Mailing Address - Phone:469-774-6746
Mailing Address - Fax:
Practice Address - Street 1:1229 E PLEASANT RUN RD STE 200
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4214
Practice Address - Country:US
Practice Address - Phone:469-774-6746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75931101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional