Provider Demographics
NPI:1881277895
Name:JAMES, LAZELLE
Entity type:Individual
Prefix:MR
First Name:LAZELLE
Middle Name:
Last Name:JAMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1477
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393-1477
Mailing Address - Country:US
Mailing Address - Phone:760-243-3999
Mailing Address - Fax:760-256-0537
Practice Address - Street 1:14344 CAJON AVE STE 101-103
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-4300
Practice Address - Country:US
Practice Address - Phone:760-243-3999
Practice Address - Fax:760-256-0537
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW100381101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health