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General NPI Number Information
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NPI Number | 1366558553
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Entity Type | Organization
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Legal Business Name | MIDAMERICAN PSYCHOLOGICAL INSTITUTE PC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 1415 MAPLE RD
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City | JOLIET
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State | IL
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Zip | 60432-1442
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Country | US
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Telephone | 815-735-0732
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Fax | 815-722-7310
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Provider Business Mailing Address
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Address Line | 1415 MAPLE RD
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City | JOLIET
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State | IL
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Zip | 60432-1442
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Country | US
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Telephone | 815-735-0732
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Fax | 815-722-7310
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL J MORAN
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Credential | PHD BCBA
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Telephone | 815-735-0732
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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 | 071006470
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License Number State | IL
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