Provider Demographics
NPI:1154024487
Name:SOUTH, JAMES (LPC-IT, MS, PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SOUTH
Suffix:
Gender:M
Credentials:LPC-IT, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 S 9TH ST UNIT 2W
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-1308
Mailing Address - Country:US
Mailing Address - Phone:414-218-4102
Mailing Address - Fax:
Practice Address - Street 1:2524 E WEBSTER PL STE 203
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4257
Practice Address - Country:US
Practice Address - Phone:414-964-9200
Practice Address - Fax:414-964-4816
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7278226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health