Provider Demographics
NPI:1790814218
Name:CLINES, JAMES DAVID (MA, LMFT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DAVID
Last Name:CLINES
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 BARDSTOWN RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3241
Mailing Address - Country:US
Mailing Address - Phone:502-499-8010
Mailing Address - Fax:502-499-4134
Practice Address - Street 1:4229 BARDSTOWN RD
Practice Address - Street 2:SUITE 311
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3241
Practice Address - Country:US
Practice Address - Phone:502-499-8010
Practice Address - Fax:502-499-4134
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0546106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY-0546OtherLICENSED THERAPIST