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General NPI Number Information
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NPI Number | 1467500827
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Entity Type | Individual
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Provider Name | MICHAEL THOMAS JIARAS JR. PSY.D., M.A.
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Gender | Male
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 211 E ONTARIO ST STE 1150
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City | CHICAGO
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State | IL
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Zip | 60611-3248
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Country | US
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Telephone | 312-475-1635
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Fax | 847-316-8625
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Provider Business Mailing Address
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Address Line | 366 WINNETKA AVE
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City | WINNETKA
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State | IL
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Zip | 60093-4239
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Country | US
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Telephone | 847-501-4200
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Fax | 847-316-8625
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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 |
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License Number State | IL
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