| Doctor Name: | DORIS M VAN BYSSUM |
| NPI Number: | 1063515369 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | 209.010527041.189584 |
| Business Practice Address: | 45 S Park Blvd Suite 130 Glen Ellyn, IL - 601376280 |
| Business Phone Number: | 6308580875 |
| Business Fax Number: | 6308580650 |
| Mailing Address: | 45 S Park Blvd, Suite 130 GLEN ELLYN |
| State: | IL |
| Postal Code: | 601376280 |
| Phone Number: | 6308580875 |
| Fax Number: | 6308580650 |
| NPI Enumeration Date: | 09/06/2006 |
| NPI Last Update Date: | 08/02/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 209.010527041.189584 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |