Provider Demographics
NPI:1932269040
Name:ATKINSON, BRENT JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:JOSEPH
Last Name:ATKINSON
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 1:1250 EXECUTIVE PL
Mailing Address - Street 2:SUITE 501
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-3807
Mailing Address - Country:US
Mailing Address - Phone:630-232-7457
Mailing Address - Fax:630-232-7567
Practice Address - Street 1:1250 EXECUTIVE PL
Practice Address - Street 2:SUITE 501
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-3807
Practice Address - Country:US
Practice Address - Phone:630-232-7457
Practice Address - Fax:630-232-7567
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist