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General NPI Number Information
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NPI Number | 1952898280
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Entity Type | Individual
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Provider Name | JAMES MAXIE JR. MA,QMHP-CS
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Gender | Male
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 200 N THOMAS DR
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City | SHREVEPORT
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State | LA
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Zip | 71107-6503
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Country | US
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Telephone | 318-573-3942
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Fax |
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Provider Business Mailing Address
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Address Line | 1840 LOGAN ST
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City | SHREVEPORT
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State | LA
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Zip | 71101-2316
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Country | US
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Telephone | 318-573-3942
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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 | 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 | LA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State | LA
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Taxonomy #6
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | LA
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