Provider Demographics
NPI:1528655537
Name:STOTTS, JAME CAMILLE (LCSW)
Entity type:Individual
Prefix:
First Name:JAME
Middle Name:CAMILLE
Last Name:STOTTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JAME
Other - Middle Name:CAMILLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1919 NW 82ND TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-8227
Mailing Address - Country:US
Mailing Address - Phone:816-726-0721
Mailing Address - Fax:
Practice Address - Street 1:1919 NW 82ND TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-8227
Practice Address - Country:US
Practice Address - Phone:816-726-0721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220446511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1528655537Medicaid