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General NPI Number Information
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NPI Number | 1386848083
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Entity Type | Individual
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Provider Name | BRIAN KEITH PRICE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 10/20/2008
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Provider Practice Location Address
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Address Line | UNIT 29216
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City | APO
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State | AE
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Zip | 09102
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Country | US
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Telephone | 33388848592
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 JENKISSON AVE
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City | LAKE BLUFF
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State | IL
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Zip | 60044-1623
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Country | US
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Telephone | 312-972-1558
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071.007309
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License Number State | IL
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