Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | IL | |
N | 103TC0700X | Clinical Psychologist | IL | |
Y | 103G00000X | Clinical Psychologist | IL | |
Y | 103TC0700X | Clinical Psychologist | IL | |
N | 103TH0004X | Health Psychologist | IL | |
N | 103TR0400X | Rehabilitation Psychologist | IL |
NPI | 1396895454 |
---|---|
Provider Name | Dr. Timothy Donald Mcmanus |
First Address | Orland Park, IL 60462-1845 |
Second Address | Harvey, IL 60426-9988 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 27/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2207287 | BLUE CROSS BLUE SHIELD (01) | IL |