Provider Demographics
NPI:1205963782
Name:STAFFNIK, JAMES G (MA EDD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:STAFFNIK
Suffix:
Gender:M
Credentials:MA EDD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:CONCHO
Mailing Address - State:AZ
Mailing Address - Zip Code:85924
Mailing Address - Country:US
Mailing Address - Phone:928-337-2279
Mailing Address - Fax:928-337-3526
Practice Address - Street 1:450 SOUTH 13TH WEST
Practice Address - Street 2:ST JOHNS USD
Practice Address - City:ST JOHN
Practice Address - State:AZ
Practice Address - Zip Code:85936
Practice Address - Country:US
Practice Address - Phone:928-337-2279
Practice Address - Fax:928-337-3526
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
15470103TS0200X
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool