Basic Information
| Provider Information | |||||||||
| NPI: | 1770820383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAMES | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NANNEY, UTTERBACK | ||||||||
| OtherFirstName: | DAWN | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 2227 | ||||||||
| Address2: | |||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786302227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413215257 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3804 HIGHWAY 377 S | ||||||||
| Address2: | |||||||||
| City: | BROWNWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 768015120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256435157 | ||||||||
| FaxNumber: | 8662476022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2013 | ||||||||
| LastUpdateDate: | 03/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 74785 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | 74785 | TX | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.