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NPI Code Detail

MEDICARE: MR. JAMES MICHAEL GRESHAM MHP, RASI

MEDICARE: MR. JAMES MICHAEL GRESHAM MHP, RASI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1477648707
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES MICHAEL GRESHAM MHP, RASI
Provider Business Mailing Address
First Line : 2960 CHAMPION WAY APT 2608
Second Line :
City : TUSTIN
State : CA
Zip : 92782-1213
Country : US
Telephone Number : 714-225-9636
Fax Number :
Provider Business Practice Location Address
First Line : 405 W 5TH ST STE 212
Second Line :
City : SANTA ANA
State : CA
Zip : 92701-4522
Country : US
Telephone Number : 714-834-2125
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 07/08/2007

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