Provider Demographics
NPI:1831340272
Name:ARCHER, JIM BOB (M ED)
Entity type:Individual
Prefix:MR
First Name:JIM
Middle Name:BOB
Last Name:ARCHER
Suffix:
Gender:M
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10904 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-5791
Mailing Address - Country:US
Mailing Address - Phone:806-783-9370
Mailing Address - Fax:
Practice Address - Street 1:10904 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-5791
Practice Address - Country:US
Practice Address - Phone:806-783-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63018101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional