Healthcare Provider Details

I. General information

NPI: 1346208410
Provider Name (Legal Business Name): ALLAN T. PETERSON PSY. D, MDIV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W IRVING PARK RD COUNSELING CENTER
CHICAGO IL
60641-2825
US

IV. Provider business mailing address

4610 WINCHESTER AVE
LYONS IL
60534-1778
US

V. Phone/Fax

Practice location:
  • Phone: 773-736-1447
  • Fax: 773-736-6970
Mailing address:
  • Phone: 708-447-8129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: