MEDICARE: PSYCHOLOGICAL PATHWAYS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	071-006159	IL

General Provider Information

NPI Number	:	1043478621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHOLOGICAL PATHWAYS, LLC

Provider Business Mailing Address
First Line	:	3025 PARKSIDE DR
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-1038
Country	:	US
Telephone Number	:	847-577-0881
Fax Number	:	847-342-0378

Provider Business Practice Location Address
First Line	:	3800 N WILKE RD
Second Line	:	SUITE 160
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1278
Country	:	US
Telephone Number	:	847-577-0881
Fax Number	:	847-342-0378

Authorized Official
Title or Position	:	MANAGER/LICENSED CLINICAL PSYCHOLOG
Name	:	DR. ADAM GREGORY CRANE
Credential	:	PSY.D.
Telephone Number	:	847-577-0881

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	05/29/2008

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