Provider Demographics
NPI:1639482144
Name:PRICE, MIKE
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:
Last Name:PRICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7420 ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:IL
Mailing Address - Zip Code:60501-1218
Mailing Address - Country:US
Mailing Address - Phone:708-745-5277
Mailing Address - Fax:708-458-9177
Practice Address - Street 1:7420 ARCHER AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:IL
Practice Address - Zip Code:60501-1218
Practice Address - Country:US
Practice Address - Phone:708-745-5277
Practice Address - Fax:708-458-9177
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor