Provider Demographics
NPI:1972692424
Name:FOLSOM, JIM B (MA)
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:B
Last Name:FOLSOM
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 N 31ST AVE
Mailing Address - Street 2:SUITE A105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9568
Mailing Address - Country:US
Mailing Address - Phone:602-749-0171
Mailing Address - Fax:602-749-8588
Practice Address - Street 1:10000 N 31ST AVE
Practice Address - Street 2:SUITE A105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9568
Practice Address - Country:US
Practice Address - Phone:602-843-0000
Practice Address - Fax:602-843-0000
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC1772103T00000X
AZLISAC0023103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy