Provider Demographics
NPI:1831533116
Name:GILLUM, JAMES L (MS LPC CRADC CCDP-D)
Entity type:Individual
Prefix:PROF
First Name:JAMES
Middle Name:L
Last Name:GILLUM
Suffix:
Gender:M
Credentials:MS LPC CRADC CCDP-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1022 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2367
Mailing Address - Country:US
Mailing Address - Phone:417-818-7204
Mailing Address - Fax:
Practice Address - Street 1:1015 LANTON RD
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-3854
Practice Address - Country:US
Practice Address - Phone:417-256-2570
Practice Address - Fax:417-265-6497
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007015287101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)