Provider Demographics
NPI:1235206434
Name:STANELUIS, JAMES M (LPCC LICDC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:STANELUIS
Suffix:
Gender:M
Credentials:LPCC LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-2027
Mailing Address - Country:US
Mailing Address - Phone:419-893-8432
Mailing Address - Fax:419-891-5403
Practice Address - Street 1:109 W WAYNE ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-2150
Practice Address - Country:US
Practice Address - Phone:419-893-8432
Practice Address - Fax:419-891-5403
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH976085101YA0400X
OHE0002538101YP2500X
OHICAOC22266101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional