=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679249759
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES BITAH LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2021
-----------------------------------------------------
Last Update Date | 08/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 RAILROAD AVE
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87701-4533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-425-2687
-----------------------------------------------------
Fax | 505-454-7198
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 RAILROAD AVE
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87701-4533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-425-2687
-----------------------------------------------------
Fax | 505-454-7198
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | X-12107
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------