Provider Demographics
NPI:1427000678
Name:EADS, JAMES R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:EADS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4090
Practice Address - Street 1:4520 E CENTRAL TEXAS EXPY
Practice Address - Street 2:STE 111
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5276
Practice Address - Country:US
Practice Address - Phone:254-699-7222
Practice Address - Fax:254-699-7309
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS04015101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX108260403Medicaid
TX00S75COtherBLUE CROSS BLUE SHIELD
TX85530000OtherAETNA
TX100784100OtherFIRST CARE
TX7933OtherCIGNA
TX95612OtherFIRST HEALTH
TXR60001Medicare UPIN
TX85530000OtherAETNA