Provider Demographics
NPI:1053487751
Name:MYLAR, JAMES LEWIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEWIS
Last Name:MYLAR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:LEWIS
Other - Last Name:MYLAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:524 N TEJON ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903
Mailing Address - Country:US
Mailing Address - Phone:719-633-2008
Mailing Address - Fax:719-447-0771
Practice Address - Street 1:524 NORTH TEJON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903
Practice Address - Country:US
Practice Address - Phone:719-633-2008
Practice Address - Fax:719-447-0771
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
114943124OtherDUNS
COP000H90R2Medicaid
95016409OtherTPIN
95016409OtherTPIN