Provider Demographics
NPI:1780024810
Name:KEATING, WILLIAM MARK (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MARK
Last Name:KEATING
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 1:9009 MANSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-5501
Mailing Address - Country:US
Mailing Address - Phone:630-205-0847
Mailing Address - Fax:
Practice Address - Street 1:9009 MANSFIELD DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-5501
Practice Address - Country:US
Practice Address - Phone:630-205-0847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071001764103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical