Doctor Name: | MR. JAMES W MCCORMICK |
NPI Number: | 1124250881 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA |
License Number: | 2009024007 |
Business Practice Address: | 18614 Whiskey Creek Rd Wildwood, MO - 630692530 |
Business Phone Number: | 3145043828 |
Business Fax Number: | |
Mailing Address: | Po Box 220081, SAINT LOUIS |
State: | MO |
Postal Code: | 631220081 |
Phone Number: | 3145043828 |
Fax Number: | |
NPI Enumeration Date: | 08/13/2009 |
NPI Last Update Date: | 08/13/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2009024007 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |