Provider Demographics
NPI:1295254092
Name:MCCORMACK, JAMES RICHARD (MA, LMFTA, CCHT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RICHARD
Last Name:MCCORMACK
Suffix:
Gender:M
Credentials:MA, LMFTA, CCHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 6TH ST STE 135
Mailing Address - Street 2:KITSAP HYPNOSIS CENTER LLC
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337
Mailing Address - Country:US
Mailing Address - Phone:360-471-2302
Mailing Address - Fax:
Practice Address - Street 1:851 6TH ST STE 135
Practice Address - Street 2:KITSAP HYPNOSIS CENTER LLC
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337
Practice Address - Country:US
Practice Address - Phone:360-471-2302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60530579101Y00000X
WAMG60982950101Y00000X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAHP60464333OtherWA DEPARTMENT OF HEALTH
WACL60530579OtherWA DEPARTMENT OF HEALTH