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General NPI Number Information
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NPI Number | 1326319161
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Entity Type | Individual
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Provider Name | ALAN P CHILDS M.A., PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 9760 S ROBERTS RD FL 2
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City | PALOS HILLS
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State | IL
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Zip | 60465-1686
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Country | US
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Telephone | 708-422-2772
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Fax | 773-685-6744
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Provider Business Mailing Address
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Address Line | 5920 SAUGANASH LANE
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City | CHICAGO
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State | IL
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Zip | 60646
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Country | US
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Telephone | 708-422-2772
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Fax | 773-685-6744
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 071.004644
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License Number State | IL
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