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Individual

DR. YEVGENIY ISYANOV

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
8707 SKOKIE BLVD STE 207, SKOKIE, IL 60077-2269
(847) 673-8577
(847) 568-0411
Mailing address
803 S POPLAR AVE, ELMHURST, IL 60126-4544
(847) 673-8577

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
101YM0800X
Mental Health Counselor
180-004766
IL
101YP2500X
Professional Counselor
180-004766
IL
103K00000X
Behavior Analyst
103T00000X
Psychologist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
180-004766
IL LICENSE NUMBER
IL
Enumeration date
12/08/2005
Last updated
01/18/2013
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