Provider Demographics
NPI:1609111921
Name:MIERSMA, JAMES TIMOTHY
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TIMOTHY
Last Name:MIERSMA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:TIMOTHY
Other - Last Name:MIERSMA
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:10251 HACIENDA ST
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-6707
Mailing Address - Country:US
Mailing Address - Phone:562-495-0610
Mailing Address - Fax:
Practice Address - Street 1:10251 HACIENDA ST
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6707
Practice Address - Country:US
Practice Address - Phone:562-495-0610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20669103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist