Provider Demographics
NPI:1518055284
Name:JAMES, LAWRENCE JR (PHD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:JAMES
Suffix:JR
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 1:825 CARPENTER AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1108
Mailing Address - Country:US
Mailing Address - Phone:773-480-0196
Mailing Address - Fax:
Practice Address - Street 1:7001 NORTH AVE
Practice Address - Street 2:STE 201
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1025
Practice Address - Country:US
Practice Address - Phone:708-848-2492
Practice Address - Fax:413-410-0046
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005555103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL113311355OtherUNITED BEH HEALTH PROV.
IL0001625752OtherBCBS PROV. NO
IL346545000OtherMAGELLAN PROVIDER NO
IL113311355OtherUNITED BEH HEALTH PROV.