Provider Demographics
NPI:1891341947
Name:THEISS, JAMES M (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:THEISS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5439 E ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-5470
Mailing Address - Country:US
Mailing Address - Phone:480-772-0091
Mailing Address - Fax:
Practice Address - Street 1:5439 E ELLIS ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-5470
Practice Address - Country:US
Practice Address - Phone:480-772-0091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRPN230939363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health