Provider Demographics
NPI:1861603334
Name:DAKIN, JOHN B IV (MS, LMFTA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:B
Last Name:DAKIN
Suffix:IV
Gender:M
Credentials:MS, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10613 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-8249
Mailing Address - Country:US
Mailing Address - Phone:806-698-6132
Mailing Address - Fax:
Practice Address - Street 1:10613 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-8249
Practice Address - Country:US
Practice Address - Phone:806-698-6132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201112106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist