Provider Demographics
NPI:1477984706
Name:ROOT, JAMES EDWARD JR (MS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:ROOT
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3926 LEISURE LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-3502
Mailing Address - Country:US
Mailing Address - Phone:719-439-1620
Mailing Address - Fax:
Practice Address - Street 1:3926 LEISURE LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-3502
Practice Address - Country:US
Practice Address - Phone:719-439-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC0103886101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health