Provider Demographics
NPI:1134292170
Name:SELF, JAMES HERSHEL (LMFT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HERSHEL
Last Name:SELF
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3634
Mailing Address - Country:US
Mailing Address - Phone:214-732-6121
Mailing Address - Fax:214-827-4974
Practice Address - Street 1:6130 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3634
Practice Address - Country:US
Practice Address - Phone:214-732-6121
Practice Address - Fax:214-827-4974
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX948-945106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000948-000945OtherLMFT