Provider Demographics
NPI:1487716460
Name:JAMES, JANE (MS, QMHP)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:MS, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 DEER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GOREVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62939-2419
Mailing Address - Country:US
Mailing Address - Phone:618-995-9897
Mailing Address - Fax:
Practice Address - Street 1:125 N MARKET
Practice Address - Street 2:
Practice Address - City:GOLCONDA
Practice Address - State:IL
Practice Address - Zip Code:62938
Practice Address - Country:US
Practice Address - Phone:618-683-2246
Practice Address - Fax:618-683-2066
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health