Provider Demographics
NPI:1033624630
Name:VISINAIZ, JAMES JR (LCPC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:VISINAIZ
Suffix:JR
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 FAIRFIELD WAY STE 240
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1559
Mailing Address - Country:US
Mailing Address - Phone:630-309-2989
Mailing Address - Fax:630-790-3804
Practice Address - Street 1:121 FAIRFIELD WAY STE 240
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1559
Practice Address - Country:US
Practice Address - Phone:630-309-2989
Practice Address - Fax:630-790-3804
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011064101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor