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General NPI Number Information
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NPI Number | 1124446240
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Entity Type | Organization
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Legal Business Name | ML ETCHISON AND ASSOCIATES, INC.
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Dates
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Enumeration Date | 04/05/2014
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 7350 W COLLEGE DR SUITE #106
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1149
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Country | US
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Telephone | 708-269-3050
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Fax | 708-579-0169
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Provider Business Mailing Address
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Address Line | 745 N WAIOLA AVE
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City | LA GRANGE PARK
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State | IL
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Zip | 60526-1451
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Country | US
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Telephone | 708-269-3050
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Fax | 708-579-0169
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MONA LUAN ETCHISON
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Credential | PSY.D.
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Telephone | 708-269-3050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071007027
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License Number State | IL
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