Healthcare Provider Details

I. General information

NPI: 1881683969
Provider Name (Legal Business Name): JAMES T DAVENPORT PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10343 S WESTERN AVE THE PSYCHOLOGY CENTER INC
CHICAGO IL
60643-2410
US

IV. Provider business mailing address

10713 E DORIC CIR THE PSYCHOLOGY CENTER INC
PALOS HILLS IL
60465-2220
US

V. Phone/Fax

Practice location:
  • Phone: 773-238-2828
  • Fax:
Mailing address:
  • Phone: 773-238-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: