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General NPI Number Information
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NPI Number | 1114228319
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Entity Type | Organization
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Legal Business Name | PAULETTE TOBUREN PSYD INC
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Dates
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Enumeration Date | 11/04/2010
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 180 W PARK AVE SUITE 130
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City | ELMHURST
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State | IL
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Zip | 60126-3357
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Country | US
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Telephone | 630-917-3369
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Fax | 630-530-4321
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Provider Business Mailing Address
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Address Line | 225 E LEXINGTON ST
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City | ELMHURST
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State | IL
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Zip | 60126-5335
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Country | US
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Telephone | 630-917-3369
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Fax | 630-530-4321
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. PAULETTE TOBUREN
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Credential | PSY.D.
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Telephone | 630-917-3369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071004879
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License Number State | IL
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