Provider Demographics
NPI:1912009846
Name:JAMES, ALEXANDER R (PHD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:R
Last Name:JAMES
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 1:118 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-1904
Mailing Address - Country:US
Mailing Address - Phone:618-656-0696
Mailing Address - Fax:618-656-9697
Practice Address - Street 1:118 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1904
Practice Address - Country:US
Practice Address - Phone:618-656-0696
Practice Address - Fax:618-656-9697
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-003362103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
216384OtherPTAN
IL6170605OtherBC/BS ID NUMBER
319980Medicare ID - Type UnspecifiedMEDICARE ID NUMBER