Provider Demographics
NPI:1790999225
Name:CATHERALL, DONALD ROY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ROY
Last Name:CATHERALL
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 1:20 N WACKER DR
Mailing Address - Street 2:SUITE 3117
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-2806
Mailing Address - Country:US
Mailing Address - Phone:312-263-0446
Mailing Address - Fax:312-263-0477
Practice Address - Street 1:20 N WACKER DR
Practice Address - Street 2:SUITE 3117
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-2806
Practice Address - Country:US
Practice Address - Phone:312-263-0446
Practice Address - Fax:312-263-0477
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL329300Medicare ID - Type Unspecified