Provider Demographics
NPI:1215058425
Name:SLATER, JAMES MARK (MA,LLP)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MARK
Last Name:SLATER
Suffix:
Gender:M
Credentials:MA,LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 HOPKINS AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4802
Mailing Address - Country:US
Mailing Address - Phone:517-484-1376
Mailing Address - Fax:
Practice Address - Street 1:2901 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8548
Practice Address - Country:US
Practice Address - Phone:517-548-1537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006873103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral