Provider Demographics
NPI:1770986903
Name:JAMES, JOHN PHILLIP (PHD, LMHC MH15041)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PHILLIP
Last Name:JAMES
Suffix:
Gender:M
Credentials:PHD, LMHC MH15041
Other - Prefix:
Other - First Name:PHIL
Other - Middle Name:
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, LMHC MH15041
Mailing Address - Street 1:4807 SUNSET CT
Mailing Address - Street 2:APT 205
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-5040
Mailing Address - Country:US
Mailing Address - Phone:845-300-4138
Mailing Address - Fax:239-362-0710
Practice Address - Street 1:6313 CORPORATE CT STE 120
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3509
Practice Address - Country:US
Practice Address - Phone:845-300-4138
Practice Address - Fax:239-362-0710
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH15041OtherLICENSE NUMBER