Provider Demographics
NPI:1497868988
Name:MILLENNIUM PARK PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MILLENNIUM PARK PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:K
Authorized Official - Last Name:STUHR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-284-1330
Mailing Address - Street 1:30 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1103
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3402
Mailing Address - Country:US
Mailing Address - Phone:312-284-1330
Mailing Address - Fax:312-284-1331
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1103
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-284-1330
Practice Address - Fax:312-284-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634734OtherBLUE CROSS BLUE SHIELD
IL210280Medicare PIN