Healthcare Provider Details

I. General information

NPI: 1962855114
Provider Name (Legal Business Name): JAMES HARTSELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 W CHARLESTON BLVD #140
LAS VEGAS NV
89146-9001
US

IV. Provider business mailing address

6669 HAPPY CIR
LAS VEGAS NV
89120-2903
US

V. Phone/Fax

Practice location:
  • Phone: 702-437-4673
  • Fax: 702-438-4673
Mailing address:
  • Phone: 702-610-2995
  • Fax: 702-384-3142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI0872
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: