Provider Demographics
NPI:1023043627
Name:DAUM, JAMES M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:DAUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W PETE ROSE WAY
Mailing Address - Street 2:SUITE 347
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45203-1892
Mailing Address - Country:US
Mailing Address - Phone:513-961-7066
Mailing Address - Fax:937-855-7587
Practice Address - Street 1:700 W PETE ROSE WAY
Practice Address - Street 2:SUITE 347
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45203-1892
Practice Address - Country:US
Practice Address - Phone:513-961-7066
Practice Address - Fax:937-855-7587
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4602103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311364079OtherFEDERAL TAX IDENTIFICATIO
OHDACP12251Medicare PIN