Provider Demographics
NPI:1033505029
Name:ELISABETH JAMES PHD CONSULTING AND CLINICAL SERVICES
Entity Type:Organization
Organization Name:ELISABETH JAMES PHD CONSULTING AND CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:866-731-0712
Mailing Address - Street 1:4235 DEEPWOOD LN
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-5515
Mailing Address - Country:US
Mailing Address - Phone:866-731-0712
Mailing Address - Fax:419-873-6599
Practice Address - Street 1:4041 W SYLVANIA AVE
Practice Address - Street 2:STE 202
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4465
Practice Address - Country:US
Practice Address - Phone:866-731-0712
Practice Address - Fax:419-873-6599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5169103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty