Provider Demographics
NPI:1376180208
Name:JAMES, MICHAEL LEONARD II
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEONARD
Last Name:JAMES
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 HARVARD CIR APT 5
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-2248
Mailing Address - Country:US
Mailing Address - Phone:322-987-2079
Mailing Address - Fax:
Practice Address - Street 1:1512 HARVARD CIR APT 5
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2248
Practice Address - Country:US
Practice Address - Phone:322-987-2079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLJ520-552-95-292-0106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician