Provider Demographics
NPI:1083370365
Name:STALEY, JAMES NIS (LPC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:NIS
Last Name:STALEY
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 1:8326 COLEUS LN
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-8257
Mailing Address - Country:US
Mailing Address - Phone:713-309-5697
Mailing Address - Fax:
Practice Address - Street 1:8326 COLEUS LN
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-8257
Practice Address - Country:US
Practice Address - Phone:713-309-5697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional