Provider Demographics
NPI:1063566701
Name:PFEIFFER, JAMES B (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:B
Last Name:PFEIFFER
Suffix:
Gender:M
Credentials:LCSW
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 61274
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-1274
Mailing Address - Country:US
Mailing Address - Phone:361-814-2273
Mailing Address - Fax:361-814-2274
Practice Address - Street 1:4455 S PADRE ISLAND DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5101
Practice Address - Country:US
Practice Address - Phone:361-814-2273
Practice Address - Fax:361-814-2274
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165091041C0700X
TX3723106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S10TOtherBCBS IDENTIFIER NUMBER
TX119744403Medicaid