Provider Demographics
NPI:1184223133
Name:KEVIN P. MCDUNN, PSYD, LLC
Entity Type:Organization
Organization Name:KEVIN P. MCDUNN, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCDUNN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:248-396-0938
Mailing Address - Street 1:605 W MADISON ST APT 2001
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2469
Mailing Address - Country:US
Mailing Address - Phone:248-396-0938
Mailing Address - Fax:
Practice Address - Street 1:605 W MADISON ST APT 2001
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2469
Practice Address - Country:US
Practice Address - Phone:248-396-0938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1417515891OtherINDIVIDUAL NPI