Organization
MIDAMERICAN PSYCHOLOGICAL INSTITUTE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL J MORAN PHD BCBA (OWNER)
(815) 735-0732
Entity
Organization
Contact information
Practice address
1415 MAPLE RD, JOLIET, IL 60432-1442
(815) 735-0732
(815) 722-7310
Mailing address
1415 MAPLE RD, JOLIET, IL 60432-1442
(815) 735-0732
(815) 722-7310
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071006470
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9932152
BCBS GROUP NUMBER
IL
Enumeration date
08/21/2006
Last updated
11/28/2012
Update your record
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