Provider Demographics
NPI:1215330535
Name:ALSUP, JAMES CRAIG (MS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CRAIG
Last Name:ALSUP
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 S ANTIETAM RD
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-7819
Mailing Address - Country:US
Mailing Address - Phone:601-622-7475
Mailing Address - Fax:
Practice Address - Street 1:1111 S GLENSTONE AVE STE 2-100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-0318
Practice Address - Country:US
Practice Address - Phone:877-869-8911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional