Basic Information
| Provider Information | |||||||||
| NPI: | 1376520312 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEVINE | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 N WESTMORELAND RD | ||||||||
| Address2: | STE LL70 | ||||||||
| City: | LAKE FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472950340 | ||||||||
| FaxNumber: | 8472950351 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 N WESTMORELAND RD | ||||||||
| Address2: | STE LL70 | ||||||||
| City: | LAKE FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472950340 | ||||||||
| FaxNumber: | 8472950351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | IL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.