Individual
ETHAN JAMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MAT, ATC
Contact information
Practice address
515 READ ST, EVANSVILLE, IN 47710-1739
(812) 424-9291
(812) 421-2722
Mailing address
2900 CASTLE CMNS, UNIT C, NEWBURGH, IN 47630-7108
(937) 206-3960
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
36002454A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36002454A
STATE OF INDIANA
IN
Enumeration date
02/01/2017
Last updated
02/01/2017
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