Provider Demographics
NPI:1518658186
Name:JANIEL, JAMES SCOTT
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:SCOTT
Last Name:JANIEL
Suffix:
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 1:2125 BEAVER VALLEY RD APT 2
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-2471
Mailing Address - Country:US
Mailing Address - Phone:937-825-4994
Mailing Address - Fax:
Practice Address - Street 1:4201 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-1624
Practice Address - Country:US
Practice Address - Phone:927-203-2017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH183801101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)