Provider Demographics
NPI:1821537978
Name:JAMES, CLEA ROSE MIRZA
Entity Type:Individual
Prefix:
First Name:CLEA
Middle Name:ROSE MIRZA
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLEA
Other - Middle Name:ROSE
Other - Last Name:HOSKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5215 N RAVENSWOOD AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1670
Mailing Address - Country:US
Mailing Address - Phone:312-767-7855
Mailing Address - Fax:
Practice Address - Street 1:5215 N RAVENSWOOD AVE STE 211
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1670
Practice Address - Country:US
Practice Address - Phone:312-767-7855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208.000615106H00000X
IL166.001303106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist