Provider Demographics
NPI:1124124169
Name:RICHARD EISAMAN
Entity type:Organization
Organization Name:RICHARD EISAMAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:EISAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-403-4544
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-0387
Mailing Address - Country:US
Mailing Address - Phone:708-403-4544
Mailing Address - Fax:
Practice Address - Street 1:62 ORLAND SQUARE DR
Practice Address - Street 2:SUITE 003
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-6546
Practice Address - Country:US
Practice Address - Phone:708-403-4544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty