Provider Demographics
NPI:1124300124
Name:LIGGETT, JAMES RYAN
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RYAN
Last Name:LIGGETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 W BELMONT AVE
Mailing Address - Street 2:403
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6660
Mailing Address - Country:US
Mailing Address - Phone:847-331-7581
Mailing Address - Fax:
Practice Address - Street 1:2222 W BELMONT AVE
Practice Address - Street 2:403
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6660
Practice Address - Country:US
Practice Address - Phone:847-331-7581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178006564101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional