Provider Demographics
NPI:1619190196
Name:TICHENOR, JAMES L (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:TICHENOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 AUGUSTA
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2395
Mailing Address - Country:US
Mailing Address - Phone:660-665-5086
Mailing Address - Fax:660-665-5086
Practice Address - Street 1:902 E LAHARPE ST
Practice Address - Street 2:SUITE 106
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4520
Practice Address - Country:US
Practice Address - Phone:660-349-0378
Practice Address - Fax:660-665-5086
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01205103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical