Provider Demographics
NPI:1487779583
Name:SMITHERS, JAMES D (MA LCPC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:D
Last Name:SMITHERS
Suffix:
Gender:M
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W 5TH AVE
Mailing Address - Street 2:SUITE 205 I
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8965
Mailing Address - Country:US
Mailing Address - Phone:630-779-0751
Mailing Address - Fax:630-753-0942
Practice Address - Street 1:800 W 5TH AVE
Practice Address - Street 2:SUITE 205 I
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8965
Practice Address - Country:US
Practice Address - Phone:630-779-0751
Practice Address - Fax:630-753-0942
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232815OtherBLUECROSSBLUESHIELD