Provider Demographics
NPI:1326259003
Name:CLOSE, JAMES L II (MDIV, LMFT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:L
Last Name:CLOSE
Suffix:II
Gender:M
Credentials:MDIV, LMFT
Other - Prefix:MR
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:CLOSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9900 BROWNSBORO RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-1128
Mailing Address - Country:US
Mailing Address - Phone:502-384-2844
Mailing Address - Fax:502-384-2855
Practice Address - Street 1:8802 TRANQUIL VALLEY LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1340
Practice Address - Country:US
Practice Address - Phone:502-797-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0466106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist