Healthcare Provider Details

I. General information

NPI: 1053506071
Provider Name (Legal Business Name): JAMES CRAIG WADDLE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S SYCAMORE ST
GARDNER KS
66030-1348
US

IV. Provider business mailing address

307 E NICHOLS ST
SPRING HILL KS
66083-8503
US

V. Phone/Fax

Practice location:
  • Phone: 913-208-6972
  • Fax:
Mailing address:
  • Phone: 913-208-6972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC990
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: