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General NPI Number Information
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NPI Number | 1396977146
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Entity Type | Individual
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Provider Name | MICHELLE DIANE JAMES PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/12/2009
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Last Update Date | 08/14/2009
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Provider Practice Location Address
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Address Line | 1871 N CLYBOURN AVE SUITE 224
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City | CHICAGO
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State | IL
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Zip | 60614-4947
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Country | US
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Telephone | 773-913-2029
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Fax | 847-635-1764
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Provider Business Mailing Address
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Address Line | 6727 S OGLESBY AVE # C1
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City | CHICAGO
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State | IL
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Zip | 60649-1315
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Country | US
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Telephone | 773-913-2029
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Fax | 847-635-1764
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071-005919
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-005919
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | 071-005919
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License Number State | IL
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