=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801993472
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES H ADAMS PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 453 CERRILLOS RD
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87501-3784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-690-4797
-----------------------------------------------------
Fax | 505-989-8683
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 31428
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87594-1428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-690-4797
-----------------------------------------------------
Fax | 505-989-8683
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 729
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------