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General NPI Number Information
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NPI Number | 1265791859
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Entity Type | Individual
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Provider Name | JAMES WILSON MCDERMOTT M.A.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 05/16/2012
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Provider Practice Location Address
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Address Line | 9040 HARRATT ST 35
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-3859
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Country | US
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Telephone | 424-202-8973
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Fax |
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Provider Business Mailing Address
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Address Line | 9040 HARRATT ST 35
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-3859
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Country | US
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Telephone | 424-202-8973
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1065
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 42673
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License Number State | CA
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