Healthcare Provider Details

I. General information

NPI: 1588119812
Provider Name (Legal Business Name): JAMES DYSON COUNSLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7465 W LAKE MEAD BLVD STE 121
LAS VEGAS NV
89128-1033
US

IV. Provider business mailing address

7465 W LAKE MEAD BLVD STE 121
LAS VEGAS NV
89128-1033
US

V. Phone/Fax

Practice location:
  • Phone: 702-562-8167
  • Fax: 702-562-8111
Mailing address:
  • Phone: 702-562-8167
  • Fax: 702-562-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: