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NPI Code Detail

MEDICARE: EMOTION MANAGEMENT PROGRAM LLC

MEDICARE: EMOTION MANAGEMENT PROGRAM 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
1101YM0800XMental Health Counselor180000522IL
2103TC0700XClinical Psychologist071005108IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1279826OTHERILMAGELLAN
201634764OTHERILBCBSIL PPO

General Provider Information

NPI Number : 1083780522
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMOTION MANAGEMENT PROGRAM LLC
Provider Business Mailing Address
First Line : PO BOX 747
Second Line :
City : BLUE ISLAND
State : IL
Zip : 60406-0747
Country : US
Telephone Number : 708-403-7570
Fax Number : 708-403-7546
Provider Business Practice Location Address
First Line : 1800 RAVINIA PL
Second Line :
City : ORLAND PARK
State : IL
Zip : 60462-3761
Country : US
Telephone Number : 708-403-7570
Fax Number : 708-403-7546
Authorized Official
Title or Position : MANAGING PARTNER
Name : DR. EUGENE PAUL HOLMES
Credential : PSY.D.
Telephone Number : 708-403-7580
Provider Enumeration Date : 11/27/2006
Last Update Date : 07/30/2010

Similar Medicare Providers

1790861664 — DR. EUGENE PAUL HOLMES PSY.D.
Practice Location Address:
1800 RAVINIA PL
ORLAND PARK, IL
60462-3761
Practice Phone: 708-403-7570
Practice Fax: 708-403-7546
1639495583 — MRS. SARAH ELIZABETH JAIN LCSW
Practice Location Address:
1800 RAVINIA PL
ORLAND PARK, IL
60462-3761
Practice Phone: 708-403-7570
Practice Fax: 708-403-7546
1851647150 — MS. ROCHELLE J MCGHEE M.A., L.C.P.C.
Practice Location Address:
1800 RAVINIA PL
ORLAND PARK, IL
60462-3761
Practice Phone: 312-618-9697
Practice Fax:
1790234292 — MAXWELL WOLCOTT
Practice Location Address:
1800 RAVINIA PL
ORLAND PARK, IL
60462-3761
Practice Phone: 301-717-9173
Practice Fax:
1750806931 — ANNI RASMUSSEN LCPC, CADC
Practice Location Address:
1800 RAVINIA PL
ORLAND PARK, IL
60462-3761
Practice Phone: 708-403-7570
Practice Fax:
1437660545 — EMILY STUART-MORSE LSW
Practice Location Address:
1800 RAVINIA PL
ORLAND PARK, IL
60462-3761
Practice Phone: 708-403-7570
Practice Fax:

Directions to “EMOTION MANAGEMENT PROGRAM LLC ” Practice Location

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