Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YM0800X | Mental Health Counselor | ||
N | 103K00000X | Behavior Analyst | ||
N | 103TF0000X | Family Psychologist | ||
N | 106E00000X | Assistant Behavior Analyst |
NPI | 1164912283 |
---|---|
Provider Name | Jerry L Price JR. |
First Address | Chicago, IL 60660-2727 |
Second Address | Berwyn, IL 60402-2755 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2018 |
Last Update Date | 14/05/2018 |