Provider Demographics
NPI:1326319161
Name:CHILDS, ALAN P (MA, PSYD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:P
Last Name:CHILDS
Suffix:
Gender:M
Credentials:MA, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5920 SAUGANASH LANE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646
Mailing Address - Country:US
Mailing Address - Phone:708-422-2772
Mailing Address - Fax:773-685-6744
Practice Address - Street 1:9760 S ROBERTS RD FL 2
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1686
Practice Address - Country:US
Practice Address - Phone:708-422-2772
Practice Address - Fax:773-685-6744
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL071.004644103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1205903697OtherGROUP NPI DR. ALAN P. CHILDS AND ASSOCIATES