Provider Demographics
NPI:1750303772
Name:ADAMS, JOHN E (LICENSED CLINICAL SO)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:E
Last Name:ADAMS
Suffix:
Gender:M
Credentials:LICENSED CLINICAL SO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8291 N VIEW CRST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86315-6855
Mailing Address - Country:US
Mailing Address - Phone:520-664-7520
Mailing Address - Fax:
Practice Address - Street 1:8291 N VIEW CRST
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86315-6855
Practice Address - Country:US
Practice Address - Phone:520-664-7520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-185611041C0700X
UT372115-35011041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTLICENSEB0902Medicaid
Q22491Medicare UPIN