Healthcare Provider Details

I. General information

NPI: 1750564852
Provider Name (Legal Business Name): JAMES MCCOLLUM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3368 SACRAMENTO ST
SAN FRANCISCO CA
94118-1912
US

IV. Provider business mailing address

204 CLEMENT ST
SAN FRANCISCO CA
94118-2408
US

V. Phone/Fax

Practice location:
  • Phone: 415-484-9546
  • Fax:
Mailing address:
  • Phone: 415-484-9546
  • Fax: 415-484-1246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number29263
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: