Provider Demographics
NPI:1396977146
Name:JAMES, MICHELLE DIANE (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DIANE
Last Name:JAMES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6727 S OGLESBY AVE
Mailing Address - Street 2:# C1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-1315
Mailing Address - Country:US
Mailing Address - Phone:773-913-2029
Mailing Address - Fax:847-635-1764
Practice Address - Street 1:1871 N CLYBOURN AVE
Practice Address - Street 2:SUITE 224
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4947
Practice Address - Country:US
Practice Address - Phone:773-913-2029
Practice Address - Fax:847-635-1764
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005919103T00000X, 103TC0700X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy