Provider Demographics
NPI:1922159615
Name:NAKLES, JOHN-MICHAEL (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JOHN-MICHAEL
Middle Name:
Last Name:NAKLES
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 220
Mailing Address - Street 2:
Mailing Address - City:LUDOWICI
Mailing Address - State:GA
Mailing Address - Zip Code:31316-0220
Mailing Address - Country:US
Mailing Address - Phone:912-545-9928
Mailing Address - Fax:912-545-9830
Practice Address - Street 1:16 RESIDENCE STREET
Practice Address - Street 2:
Practice Address - City:LUDOWICI
Practice Address - State:GA
Practice Address - Zip Code:31316
Practice Address - Country:US
Practice Address - Phone:912-545-9928
Practice Address - Fax:912-545-9830
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000799106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist