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NPI Code Detail

MEDICARE: JAMES CODY BOTHE

MEDICARE: JAMES CODY BOTHE
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) CounselorSW17425FL

General Provider Information

NPI Number : 1942818513
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES CODY BOTHE
Provider Business Mailing Address
First Line : 13046 52ND CT N
Second Line :
City : ROYAL PALM BEACH
State : FL
Zip : 33411-8168
Country : US
Telephone Number : 561-255-5895
Fax Number :
Provider Business Practice Location Address
First Line : 415 S FEDERAL HWY
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33435-4931
Country : US
Telephone Number : 866-411-3096
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2020
Last Update Date : 10/07/2021

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