Provider Demographics
NPI:1396289716
Name:FANDIALAN, JAMES LLOYD (MA, LPCC 7084)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LLOYD
Last Name:FANDIALAN
Suffix:
Gender:M
Credentials:MA, LPCC 7084
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N BROOKHURST ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5226
Mailing Address - Country:US
Mailing Address - Phone:714-490-7711
Mailing Address - Fax:
Practice Address - Street 1:2150 N 1ST ST STE 650
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-2031
Practice Address - Country:US
Practice Address - Phone:408-964-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCI 3068101YM0800X
CA7084101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health