MEDICARE: CAROL ANN JAMES LPC/MHSP-S

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
1	101YM0800X	Mental Health Counselor
2	101YM0800X	Mental Health Counselor	2900	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2900	OTHER	TN	LPC/MHSP-S

General Provider Information

NPI Number	:	1720127350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL ANN JAMES LPC/MHSP-S

Provider Business Mailing Address
First Line	:	1716 MEMORIAL DR
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-4542
Country	:	US
Telephone Number	:	931-220-0522
Fax Number	:

Provider Business Practice Location Address
First Line	:	1716 MEMORIAL DR
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-4542
Country	:	US
Telephone Number	:	931-220-0522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	09/30/2020

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