Provider Demographics
NPI:1235100140
Name:MICHAEL J. ATHANS, PH.D. AND ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:MICHAEL J. ATHANS, PH.D. AND ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ATHANS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-823-4444
Mailing Address - Street 1:32 MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4060
Mailing Address - Country:US
Mailing Address - Phone:847-823-4444
Mailing Address - Fax:847-823-4456
Practice Address - Street 1:32 MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4060
Practice Address - Country:US
Practice Address - Phone:847-823-4444
Practice Address - Fax:847-823-4456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003398103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633134OtherBLUE CROSS PROVIDER NUMBE
IL01633134OtherBLUE CROSS PROVIDER NUMBE