Provider Demographics
NPI:1427204296
Name:DAVISON, MICHAEL R (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:DAVISON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3295 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1565
Mailing Address - Country:US
Mailing Address - Phone:847-490-7689
Mailing Address - Fax:
Practice Address - Street 1:3295 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1565
Practice Address - Country:US
Practice Address - Phone:847-490-7689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005382103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071005382OtherSTATE LICENCE