Healthcare Provider Details

I. General information

NPI: 1265306393
Provider Name (Legal Business Name): AMANDA JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 WILLIAMSBURG ST
LAKE CHARLES LA
70605-5720
US

IV. Provider business mailing address

127 WILLIAMSBURG ST
LAKE CHARLES LA
70605-5719
US

V. Phone/Fax

Practice location:
  • Phone: 337-437-4014
  • Fax:
Mailing address:
  • Phone: 337-376-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPLC11358
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: