Provider Demographics
NPI:1407025091
Name:EDGREN, JAMES F (LCPC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:F
Last Name:EDGREN
Suffix:
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 1:5733 N. SHERIDAN RD
Mailing Address - Street 2:3-C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4745
Mailing Address - Country:US
Mailing Address - Phone:773-860-4981
Mailing Address - Fax:
Practice Address - Street 1:5733 N. SHERIDAN RD
Practice Address - Street 2:3-C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4745
Practice Address - Country:US
Practice Address - Phone:773-860-4981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional