Provider Demographics
NPI:1205993318
Name:HARRIS, JAMES RUSSELL II (PSYD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RUSSELL
Last Name:HARRIS
Suffix:II
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SOUTH MICHIGAN
Mailing Address - Street 2:SUITE 1025
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-6264
Mailing Address - Country:US
Mailing Address - Phone:312-765-0677
Mailing Address - Fax:
Practice Address - Street 1:122 SOUTH MICHIGAN
Practice Address - Street 2:SUITE 1025
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6264
Practice Address - Country:US
Practice Address - Phone:312-765-0677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL639130Medicare ID - Type Unspecified