Provider Demographics
NPI:1477892081
Name:IKONOMOPOULOS, JAMES P (PHD, LPC-S)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:IKONOMOPOULOS
Suffix:
Gender:M
Credentials:PHD, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 SHADI ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-7013
Mailing Address - Country:US
Mailing Address - Phone:361-425-4684
Mailing Address - Fax:
Practice Address - Street 1:4646 CORONA DR STE 140
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4302
Practice Address - Country:US
Practice Address - Phone:361-425-4684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67746101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3123812-02Medicaid