Individual
MR. JOHNNY A CORTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1500 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3318
(573) 778-4746
Mailing address
1500 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3318
(573) 686-4151
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
55920
TX
1041C0700X
Clinical Social Worker
Primary
55920
TX
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
12/22/2011
Last updated
09/01/2020
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