Provider Demographics
NPI:1053506071
Name:WADDLE, JAMES CRAIG (LPC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CRAIG
Last Name:WADDLE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 E NICHOLS ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-8503
Mailing Address - Country:US
Mailing Address - Phone:913-208-6972
Mailing Address - Fax:
Practice Address - Street 1:115 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-1348
Practice Address - Country:US
Practice Address - Phone:913-208-6972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC990101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor