Provider Demographics
NPI:1356451009
Name:CENTER FOR RURAL PSYCHOLOGY
Entity Type:Organization
Organization Name:CENTER FOR RURAL PSYCHOLOGY
Other - Org Name:HEARTLAND COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MANGIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-365-0899
Mailing Address - Street 1:PO BOX 8071
Mailing Address - Street 2:
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-8071
Mailing Address - Country:US
Mailing Address - Phone:630-365-0899
Mailing Address - Fax:630-365-9150
Practice Address - Street 1:106 W PIERCE ST
Practice Address - Street 2:
Practice Address - City:ELBURN
Practice Address - State:IL
Practice Address - Zip Code:60119-8201
Practice Address - Country:US
Practice Address - Phone:630-365-0899
Practice Address - Fax:630-365-9150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210835Medicare PIN