James Hubert Shackelford, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071002782 Issued in IL

Practice address

1113 S Milwaukee Ave
Ste 104
Libertyville, IL 60048-3758

Phone

(847) 367-5991

Fax

(847) 367-5997

NPI assigned

Jun 30, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589932800000",
    "number": "1326077785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1113 S MILWAUKEE AVE",
            "address_2": "STE 104",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483759",
            "telephone_number": "847-367-5991",
            "fax_number": "847-367-5997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113 S MILWAUKEE AVE",
            "address_2": "STE 104",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483758",
            "telephone_number": "847-367-5991",
            "fax_number": "847-367-5997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "JAMES",
        "middle_name": "HUBERT",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2020-05-20",
        "certification_date": "2020-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071002782",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "24159",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "166000265",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071002782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Serviss
• Lauren Marie Sexton
• Justin D Seyl
• Rebecca Seymour, DPT
• Isabella Sgarbossa, M.S. CCC-SLP
• Brenda Nichols Shafer, LSW
• Murjana Shah-Vonau
• Jai Devendra Shah, M.D., M.B.A., M.P.H.
• Jigna B Shah, LCPC
• Lisa Shah

• Clinical Psychologist in Libertyville, IL
• Providers in Libertyville, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.