Provider Demographics
NPI:1083780522
Name:EMOTION MANAGEMENT PROGRAM LLC
Entity Type:Organization
Organization Name:EMOTION MANAGEMENT PROGRAM LLC
Other - Org Name:EMOTION MANAGEMENT PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-403-7580
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-0747
Mailing Address - Country:US
Mailing Address - Phone:708-403-7570
Mailing Address - Fax:708-403-7546
Practice Address - Street 1:1800 RAVINIA PL
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3761
Practice Address - Country:US
Practice Address - Phone:708-403-7570
Practice Address - Fax:708-403-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180000522101YM0800X
IL071005108103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL279826OtherMAGELLAN
IL01634764OtherBCBSIL PPO
IL01634764OtherBCBSIL PPO