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General NPI Number Information
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NPI Number | 1447563903
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Entity Type | Individual
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Provider Name | DOUGLAS NEAL CRAIG II PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 1800 NATIONS DR SUITE 208
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City | GURNEE
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State | IL
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Zip | 60031-9168
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Country | US
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Telephone | 773-456-3156
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Fax |
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Provider Business Mailing Address
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Address Line | 7N699 WAGONTIRE RD
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City | ST CHARLES
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State | IL
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Zip | 60175-6620
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Country | US
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Telephone | 773-456-3156
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071007815
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License Number State | IL
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