Provider Demographics
NPI:1922191881
Name:STEFURAK, JAMES R (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:STEFURAK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 UNIVERSITY BLVD NORTH
Mailing Address - Street 2:STE 2000, UNIVERSITY COMMONS
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36688-0001
Mailing Address - Country:US
Mailing Address - Phone:251-460-7149
Mailing Address - Fax:251-460-7267
Practice Address - Street 1:307 UNIVERSITY BLVD NORTH
Practice Address - Street 2:STE 2000, UNIVERSITY COMMONS
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-0001
Practice Address - Country:US
Practice Address - Phone:251-460-7149
Practice Address - Fax:251-460-7267
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1356103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1356OtherALABAMA LICENSE NUMBER