Provider Demographics
NPI:1710099171
Name:STRAUSS, JAMES H
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:STRAUSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 EDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-7835
Mailing Address - Country:US
Mailing Address - Phone:309-530-2872
Mailing Address - Fax:
Practice Address - Street 1:200 W FRONT ST
Practice Address - Street 2:SUITE 400A
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-5048
Practice Address - Country:US
Practice Address - Phone:309-828-2860
Practice Address - Fax:309-827-2637
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional