Doctor Name: | MR. TIMOTHY ALLEN PAVLICH |
NPI Number: | 1508915182 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCPC |
License Number: | 180-002051 |
Business Practice Address: | 1520 N Rock Run Dr Suite 22 Crest Hill, IL - 604353153 |
Business Phone Number: | 8157308900 |
Business Fax Number: | 8157300988 |
Mailing Address: | 1520 N Rock Run Dr, Suite 22 CREST HILL |
State: | IL |
Postal Code: | 604353153 |
Phone Number: | 8157308900 |
Fax Number: | 8157300988 |
NPI Enumeration Date: | 01/10/2007 |
NPI Last Update Date: | 11/18/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 180-002051 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |