Provider Demographics
NPI:1497468862
Name:COSTELLO, JAMES WILLIAM (MS, MSHS, MBA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILLIAM
Last Name:COSTELLO
Suffix:
Gender:M
Credentials:MS, MSHS, MBA
Other - Prefix:MR
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:COSTELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNGS, FSSRP
Mailing Address - Street 1:PO BOX 400787
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140-0787
Mailing Address - Country:US
Mailing Address - Phone:702-367-7777
Mailing Address - Fax:
Practice Address - Street 1:5145 S DURANGO DR STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-0161
Practice Address - Country:US
Practice Address - Phone:702-367-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
No171400000XOther Service ProvidersHealth & Wellness Coach