Provider Demographics
NPI:1932282514
Name:BLAND, MICHAEL J (PSYD, DMIN, LCPC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:BLAND
Suffix:
Gender:M
Credentials:PSYD, DMIN, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 W BUENA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1646
Mailing Address - Country:US
Mailing Address - Phone:773-404-8161
Mailing Address - Fax:773-404-8162
Practice Address - Street 1:856 W BUENA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1646
Practice Address - Country:US
Practice Address - Phone:773-404-8161
Practice Address - Fax:773-404-8162
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003122101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health