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General NPI Number Information
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NPI Number | 1053506071
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Entity Type | Individual
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Provider Name | JAMES CRAIG WADDLE LPC
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Gender | Male
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 05/29/2009
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Provider Practice Location Address
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Address Line | 115 S SYCAMORE ST
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City | GARDNER
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State | KS
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Zip | 66030-1348
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Country | US
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Telephone | 913-208-6972
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Fax |
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Provider Business Mailing Address
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Address Line | 307 E NICHOLS ST
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City | SPRING HILL
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State | KS
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Zip | 66083-8503
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Country | US
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Telephone | 913-208-6972
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC990
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License Number State | KS
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