Provider Demographics
NPI:1962586180
Name:MINTO, JAMES GORDON JR (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GORDON
Last Name:MINTO
Suffix:JR
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
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Mailing Address - Street 1:4702 WESLEY ST STE D
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-5663
Mailing Address - Country:US
Mailing Address - Phone:903-455-4114
Mailing Address - Fax:903-455-2814
Practice Address - Street 1:3000 POLAR LN STE 101
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3065
Practice Address - Country:US
Practice Address - Phone:844-824-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX359831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1756453OtherFIRST HEALTH
TX0007800054OtherAETNA
TX079049OtherVALUE OPTIONS/NORTHSTAR
TX143465603Medicaid
TX244277OtherCOMPSYCH
TX00007JBOtherBLUE CROSS BLUE SHIELD
TX146452000OtherMAGELLAN HEALTH
TN203630OtherMHN
TX317895OtherPRIVATE HEALTHCARE SYSTEM