Provider Demographics
NPI:1003932039
Name:HEART LIGHT PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:HEART LIGHT PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:NEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-205-5698
Mailing Address - Street 1:747 LAKE COOK RD STE 105W
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4935
Mailing Address - Country:US
Mailing Address - Phone:847-205-5698
Mailing Address - Fax:847-205-5699
Practice Address - Street 1:747 LAKE COOK RD STE 105W
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4935
Practice Address - Country:US
Practice Address - Phone:847-205-5698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty