Provider Demographics
NPI:1518305598
Name:PRATER, MISKA (PSYD)
Entity Type:Individual
Prefix:
First Name:MISKA
Middle Name:
Last Name:PRATER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 W MONTROSE AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1561
Mailing Address - Country:US
Mailing Address - Phone:773-217-8364
Mailing Address - Fax:
Practice Address - Street 1:2650 W MONTROSE AVE STE 307
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1561
Practice Address - Country:US
Practice Address - Phone:773-217-8364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.08465103T00000X
OHC.1801563101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist