Provider Demographics
NPI:1679059497
Name:MEHTA, NEEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NEEL
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 REGENT DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1745
Mailing Address - Country:US
Mailing Address - Phone:630-915-0369
Mailing Address - Fax:
Practice Address - Street 1:11800 S 75TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1033
Practice Address - Country:US
Practice Address - Phone:708-671-8440
Practice Address - Fax:708-671-8446
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-15
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009624103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty