NPI 1134667900

Ethan James, MATATC

Practitioner Prevention Professional Evansville, IN

Practice location

Address: 515 Read St, Evansville, IN 47710-1739
Phone: (812) 424-9291
Fax: (812) 421-2722
Mailing address: 2900 Castle Cmns Unit C, Newburgh, IN 47630-7108

Registered specialties

Prevention Professional Primary

Other Service Providers Taxonomy 405300000X Licence 36002454A (IN)

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Registry record

NPI: 1134667900
Entity type: Individual
Sex (as registered): Male
NPI issued: 1 Feb 2017
Record last updated: 1 Feb 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.