Basic Information
| Provider Information | |||||||||
| NPI: | 1417388679 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAMES | ||||||||
| FirstName: | BENJAMIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6626 E. 75TH ST. | ||||||||
| Address2: | STE 500 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176217561 | ||||||||
| FaxNumber: | 3173556096 | ||||||||
| Practice Location | |||||||||
| Address1: | 6950 HILLSDALE CT | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176217740 | ||||||||
| FaxNumber: | 3176217608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2013 | ||||||||
| LastUpdateDate: | 11/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YS0200X | 35001812A | IN | N | Behavioral Health & Social Service Providers | Counselor | School | 106H00000X | 35001812A | IN | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.