Provider Demographics
NPI:1154792919
Name:NOLAN, JAMES M (LPCC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:NOLAN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 CONTENTA RDG
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-6603
Mailing Address - Country:US
Mailing Address - Phone:505-699-7616
Mailing Address - Fax:
Practice Address - Street 1:4719 CONTENTA RDG
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-6603
Practice Address - Country:US
Practice Address - Phone:505-699-7616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1382103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1382OtherPH.D. PSYCHOLOGIST