Provider Demographics
NPI:1265623631
Name:PREPURA, WAYNE ANDREW (PHD COUNSELLING PSYC)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ANDREW
Last Name:PREPURA
Suffix:
Gender:M
Credentials:PHD COUNSELLING PSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W PETERSON RD
Mailing Address - Street 2:ALLIED PSYCHOLOGICAL SERVICES LTD
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048
Mailing Address - Country:US
Mailing Address - Phone:847-680-3828
Mailing Address - Fax:847-680-3844
Practice Address - Street 1:501 W PETERSON RD
Practice Address - Street 2:ALLIED PSYCHOLOGICAL SERVICES LTD
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048
Practice Address - Country:US
Practice Address - Phone:847-680-3828
Practice Address - Fax:847-680-3844
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4923581OtherBLUE CROSS BLUE SHIELD OF