Provider Demographics
NPI:1952030256
Name:SPEARS, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SPEARS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11495 PENNSYLVANIA ST STE 126
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-6804
Mailing Address - Country:US
Mailing Address - Phone:317-855-0910
Mailing Address - Fax:
Practice Address - Street 1:11495 PENNSYLVANIA ST STE 126
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6804
Practice Address - Country:US
Practice Address - Phone:317-643-3775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004320A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health