Provider Demographics
NPI:1285678243
Name:BISSELL, JAMES (MA, LCPC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:BISSELL
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 1:1968 W FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1079
Mailing Address - Country:US
Mailing Address - Phone:773-334-8812
Mailing Address - Fax:
Practice Address - Street 1:5214 N WESTERN AVE
Practice Address - Street 2:SUITE 151
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2589
Practice Address - Country:US
Practice Address - Phone:312-458-9215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor