Provider Demographics
NPI:1124860341
Name:JAMES, CARSON DANIEL (LMHP)
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:DANIEL
Last Name:JAMES
Suffix:
Gender:M
Credentials:LMHP
Other - Prefix:
Other - First Name:CARSON
Other - Middle Name:D
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHP
Mailing Address - Street 1:5730 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-1580
Mailing Address - Country:US
Mailing Address - Phone:773-413-1700
Mailing Address - Fax:
Practice Address - Street 1:5730 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-1580
Practice Address - Country:US
Practice Address - Phone:773-413-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TS0200X
IN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool