Provider Demographics
NPI:1013782101
Name:SCHLOSS, JAMES D JR
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:SCHLOSS
Suffix:JR
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 1:259 BLUEBERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-7305
Mailing Address - Country:US
Mailing Address - Phone:575-425-1909
Mailing Address - Fax:
Practice Address - Street 1:259 BLUEBERRY HILL RD
Practice Address - Street 2:
Practice Address - City:EL PRADO
Practice Address - State:NM
Practice Address - Zip Code:87529-7305
Practice Address - Country:US
Practice Address - Phone:575-425-1909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCAD0194181101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)