MEDICARE: MRS. CRYSTAL CLAYTEL JAMES LMSW

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
1	1041C0700X	Clinical Social Worker	LMSW 39205	TX

General Provider Information

NPI Number	:	1477784502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CRYSTAL CLAYTEL JAMES LMSW

Provider Business Mailing Address
First Line	:	1903 BRIARCREEK BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77073-1568
Country	:	US
Telephone Number	:	281-645-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	3008 BLODGETT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-5304
Country	:	US
Telephone Number	:	281-501-0551
Fax Number	:	281-501-0638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2009
Last Update Date	:	01/30/2014

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