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General NPI Number Information
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NPI Number | 1962586180
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Entity Type | Individual
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Provider Name | JAMES GORDON MINTO JR. MSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 3000 POLAR LN STE 101
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City | CEDAR PARK
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State | TX
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Zip | 78613-3065
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Country | US
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Telephone | 844-824-8775
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Fax |
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Provider Business Mailing Address
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Address Line | 4702 WESLEY ST STE D
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City | GREENVILLE
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State | TX
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Zip | 75401-5663
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Country | US
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Telephone | 903-455-4114
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Fax | 903-455-2814
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 35983
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License Number State | TX
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