Provider Demographics
NPI:1790866358
Name:PROW, JAMES H (LPC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:H
Last Name:PROW
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1298 N 390TH AVE
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:IL
Mailing Address - Zip Code:62360-2106
Mailing Address - Country:US
Mailing Address - Phone:217-656-3201
Mailing Address - Fax:
Practice Address - Street 1:2272 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2215
Practice Address - Country:US
Practice Address - Phone:217-224-5416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005029236101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional