Provider Demographics
NPI:1750564852
Name:MCCOLLUM, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MCCOLLUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CLEMENT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2408
Mailing Address - Country:US
Mailing Address - Phone:415-484-9546
Mailing Address - Fax:415-484-1246
Practice Address - Street 1:204 CLEMENT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2408
Practice Address - Country:US
Practice Address - Phone:415-484-9546
Practice Address - Fax:415-484-1246
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA29263103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program