Provider Demographics
NPI:1851701197
Name:DONCKELS, JAMES MICHAEL (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:DONCKELS
Suffix:
Gender:M
Credentials:LMFT
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 10427
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-0427
Mailing Address - Country:US
Mailing Address - Phone:909-884-0133
Mailing Address - Fax:909-384-0734
Practice Address - Street 1:1881 BUSINESS CENTER DRIVE
Practice Address - Street 2:SUITE 11
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3438
Practice Address - Country:US
Practice Address - Phone:909-884-0133
Practice Address - Fax:909-384-0734
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43947106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA43947OtherLICENSE