Provider Demographics
NPI:1023059292
Name:WILLCOCKSON, JAMES C (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:WILLCOCKSON
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 1:984180 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-4180
Mailing Address - Country:US
Mailing Address - Phone:402-559-4364
Mailing Address - Fax:
Practice Address - Street 1:984180 NEBRASKA MEDICAL CTR
Practice Address - Street 2:EMILE AT 42ND ST.
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-4180
Practice Address - Country:US
Practice Address - Phone:402-559-4364
Practice Address - Fax:402-559-9107
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE247103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE269909Medicare ID - Type Unspecified
R81685Medicare UPIN