Provider Demographics
NPI:1720607526
Name:MCGUFFIN, JAMES JOSEPH (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
Last Name:MCGUFFIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:JIMMY
Other - Middle Name:J
Other - Last Name:MCGUFFIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3423 LAKEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-6806
Mailing Address - Country:US
Mailing Address - Phone:817-564-6061
Mailing Address - Fax:
Practice Address - Street 1:202 W SANDY LAKE RD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2201
Practice Address - Country:US
Practice Address - Phone:817-330-9667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-11
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPRE-LICENSED103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist