Provider Demographics
NPI:1013549948
Name:MAGER, JAMES STACEY (MED)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:STACEY
Last Name:MAGER
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 S HOUSEMAN ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-9197
Mailing Address - Country:US
Mailing Address - Phone:812-240-0903
Mailing Address - Fax:
Practice Address - Street 1:4450 S HOUSEMAN ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-9197
Practice Address - Country:US
Practice Address - Phone:812-240-0903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-09
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty