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NPI Code Detail

MEDICARE: JAMES CORLEY BS

MEDICARE: JAMES CORLEY BS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265550933
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES CORLEY BS
Provider Business Mailing Address
First Line : 2049 SKYLINE DR
Second Line :
City : LEMON GROVE
State : CA
Zip : 91945-4221
Country : US
Telephone Number : 619-465-0733
Fax Number :
Provider Business Practice Location Address
First Line : 2049 SKYLINE DR
Second Line :
City : LEMON GROVE
State : CA
Zip : 91945-4221
Country : US
Telephone Number : 619-469-4325
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2007
Last Update Date : 06/10/2010

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