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General NPI Number Information
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NPI Number | 1194928333
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Entity Type | Individual
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Provider Name | JAMES BRIAN CONANT PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 04/22/2021
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Provider Practice Location Address
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Address Line | 1901 W HARRISON ST
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City | CHICAGO
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State | IL
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Zip | 60612-3714
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Country | US
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Telephone | 312-433-4925
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Fax |
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Provider Business Mailing Address
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Address Line | 4406 N GREENVIEW AVE
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City | CHICAGO
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State | IL
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Zip | 60640-5904
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Country | US
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Telephone | 312-933-9664
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071006995
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License Number State | IL
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