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General NPI Number Information
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NPI Number | 1295715019
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Entity Type | Individual
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Provider Name | JAMES BRUCE HERTEL JR. PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1316 OLD HIGHWAY 63 SOUTH SUITE 101
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City | COLUMBIA
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State | MO
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Zip | 65201-6092
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Country | US
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Telephone | 573-424-2605
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Fax | 573-441-1223
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Provider Business Mailing Address
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Address Line | 2801 LYNNWOOD DRIVE
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City | COLUMBIA
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State | MO
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Zip | 65203-2940
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Country | US
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Telephone | 573-441-1223
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Fax | 573-441-1223
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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 | 002101
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2002022912
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License Number State | MO
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