Provider Demographics
NPI:1669729794
Name:MEL KIMMEL PHD PC
Entity type:Organization
Organization Name:MEL KIMMEL PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:KIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-344-1082
Mailing Address - Street 1:1649 W WINONA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2707
Mailing Address - Country:US
Mailing Address - Phone:312-344-1082
Mailing Address - Fax:312-674-7195
Practice Address - Street 1:333 N MICHIGAN AVE
Practice Address - Street 2:SUITE 711
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-3901
Practice Address - Country:US
Practice Address - Phone:312-344-1082
Practice Address - Fax:312-674-7195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008204103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty