=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750100608
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA JAMES PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2024
-----------------------------------------------------
Last Update Date | 10/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7676 SEXAUER DR
-----------------------------------------------------
City | BELVIDERE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61008-8956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-320-6998
-----------------------------------------------------
Fax | 779-552-9981
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7676 SEXAUER DR
-----------------------------------------------------
City | BELVIDERE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61008-8956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-320-6998
-----------------------------------------------------
Fax | 779-552-9981
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------