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General NPI Number Information
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NPI Number | 1770986903
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Entity Type | Individual
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Provider Name | JOHN PHILLIP JAMES PHD, LMHC MH15041
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Gender | Male
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 6313 CORPORATE CT STE 120
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City | FORT MYERS
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State | FL
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Zip | 33919-3509
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Country | US
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Telephone | 845-300-4138
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Fax | 239-362-0710
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Provider Business Mailing Address
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Address Line | 4807 SUNSET CT APT 205
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City | CAPE CORAL
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State | FL
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Zip | 33904-5040
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Country | US
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Telephone | 845-300-4138
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Fax | 239-362-0710
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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