Provider Demographics
NPI:1598753295
Name:DAVIDSON, JAMES W (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7800 PRESTON RD
Mailing Address - Street 2:STE 145
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3239
Mailing Address - Country:US
Mailing Address - Phone:440-942-0100
Mailing Address - Fax:440-942-0104
Practice Address - Street 1:4212 STATE ROUTE 306
Practice Address - Street 2:SUITE 306
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9258
Practice Address - Country:US
Practice Address - Phone:440-942-0100
Practice Address - Fax:440-942-0104
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH2534103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0104685Medicaid
OHCP15801Medicare PIN