Healthcare Provider Details

I. General information

NPI: 1679642003
Provider Name (Legal Business Name): MICHAEL L WATROUS PSYD LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 LARKIN AVE SUITE 202
ELGIN IL
60123
US

IV. Provider business mailing address

2050 LARKIN AVE SUITE 202
ELGIN IL
60123
US

V. Phone/Fax

Practice location:
  • Phone: 847-697-2400
  • Fax: 847-697-2438
Mailing address:
  • Phone: 847-697-2400
  • Fax: 847-697-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: