MEDICARE: DR. JAMES T DAVENPORT PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist		IL
2	106H00000X	Marriage & Family Therapist		IL

General Provider Information

NPI Number	:	1881683969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES T DAVENPORT PSYD

Provider Business Mailing Address
First Line	:	10713 E DORIC CIR
Second Line	:	THE PSYCHOLOGY CENTER INC
City	:	PALOS HILLS
State	:	IL
Zip	:	60465-2220
Country	:	US
Telephone Number	:	773-238-2828
Fax Number	:

Provider Business Practice Location Address
First Line	:	10343 S WESTERN AVE
Second Line	:	THE PSYCHOLOGY CENTER INC
City	:	CHICAGO
State	:	IL
Zip	:	60643-2410
Country	:	US
Telephone Number	:	773-238-2828
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	09/18/2007

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