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General NPI Number Information
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NPI Number | 1366266009
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Entity Type | Individual
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Provider Name | JAMES MCELDOWNEY SEABROOK III
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Gender | Male
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 1887 GOLD DUST LN
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City | PARK CITY
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State | UT
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Zip | 84060-7288
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Country | US
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Telephone | 856-371-6834
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3864
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City | PARK CITY
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State | UT
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Zip | 84060-3864
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Country | US
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Telephone | 856-371-6834
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10793679-6004
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License Number State | UT
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