Provider Demographics
NPI:1518183946
Name:SHINDER, JAMES NORMAN (PH D, MPH)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:NORMAN
Last Name:SHINDER
Suffix:
Gender:M
Credentials:PH D, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 INTERSTATE 35 S
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-3710
Mailing Address - Country:US
Mailing Address - Phone:254-714-0189
Mailing Address - Fax:254-714-2021
Practice Address - Street 1:3925 INTERSTATE 35 S
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706-3710
Practice Address - Country:US
Practice Address - Phone:254-714-0189
Practice Address - Fax:254-714-2021
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2283103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1217663-02Medicaid