Healthcare Provider Details

I. General information

NPI: 1699237396
Provider Name (Legal Business Name): JAMES H. CUNNINGHAM III LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JIM CUNNINGHAM LPC

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 2ND ST STE U
MONUMENT CO
80132-9217
US

IV. Provider business mailing address

19615 W TOP O THE MOOR DR
MONUMENT CO
80132-9327
US

V. Phone/Fax

Practice location:
  • Phone: 719-238-5187
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number196794
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0015311
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: