Provider Demographics
NPI:1043404841
Name:JOHN G. DIMLER
Entity type:Organization
Organization Name:JOHN G. DIMLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIMLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCSW
Authorized Official - Phone:210-614-8452
Mailing Address - Street 1:4204 GARDENDALE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3132
Mailing Address - Country:US
Mailing Address - Phone:210-614-8452
Mailing Address - Fax:210-614-8561
Practice Address - Street 1:4204 GARDENDALE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3132
Practice Address - Country:US
Practice Address - Phone:210-614-8452
Practice Address - Fax:210-614-8561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14338101YP2500X
TX216501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty