MEDICARE: MR. JAMES E. WORTHAM LMFT, LCSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	C474	IN
2	101YM0800X	Mental Health Counselor	34002443A	IN

General Provider Information

NPI Number	:	1851579429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES E. WORTHAM LMFT, LCSW

Provider Business Mailing Address
First Line	:	PO BOX 40
Second Line	:
City	:	MADISON
State	:	IN
Zip	:	47250-0040
Country	:	US
Telephone Number	:	812-265-1663
Fax Number	:	888-853-0773

Provider Business Practice Location Address
First Line	:	114 E MAIN ST
Second Line	:
City	:	MADISON
State	:	IN
Zip	:	47250-3411
Country	:	US
Telephone Number	:	812-265-1663
Fax Number	:	888-853-0773

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

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	11/01/2010

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