Provider Demographics
NPI:1447669924
Name:THATCHER, JAMES TAYLOR II (MA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:TAYLOR
Last Name:THATCHER
Suffix:II
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 E FRANKLIN ST APT 7
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-2760
Mailing Address - Country:US
Mailing Address - Phone:573-694-6970
Mailing Address - Fax:
Practice Address - Street 1:1800 COMMUNITY DRIVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735
Practice Address - Country:US
Practice Address - Phone:660-885-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO345563101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional