Provider Demographics
NPI:1174874911
Name:MAXWELL, JAMES R (MA, LMFT, LMHC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:MA, LMFT, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2606
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98668-2606
Mailing Address - Country:US
Mailing Address - Phone:360-635-1422
Mailing Address - Fax:
Practice Address - Street 1:400 E EVERGREEN BLVD
Practice Address - Street 2:SUITE 301C
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3331
Practice Address - Country:US
Practice Address - Phone:360-635-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60160545101YM0800X
WALF 60160510106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health