Provider Demographics
NPI:1851579429
Name:WORTHAM, JAMES E (LMFT, LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:E
Last Name:WORTHAM
Suffix:
Gender:M
Credentials:LMFT, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-0040
Mailing Address - Country:US
Mailing Address - Phone:812-265-1663
Mailing Address - Fax:888-853-0773
Practice Address - Street 1:114 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-3411
Practice Address - Country:US
Practice Address - Phone:812-265-1663
Practice Address - Fax:888-853-0773
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INC474101YA0400X
IN34002443A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)