Provider Demographics
NPI:1295922078
Name:WOLF, JAMES MICHAEL JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:WOLF
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 COLBY ST
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:MO
Mailing Address - Zip Code:65781-8360
Mailing Address - Country:US
Mailing Address - Phone:417-685-4185
Mailing Address - Fax:
Practice Address - Street 1:1212 W LOMBARD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-2720
Practice Address - Country:US
Practice Address - Phone:417-865-1646
Practice Address - Fax:417-866-1483
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070292141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical