Provider Demographics
NPI:1205903697
Name:DR. ALAN P. CHILDS & ASSOCIATES
Entity type:Organization
Organization Name:DR. ALAN P. CHILDS & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, PSYD
Authorized Official - Phone:773-685-4993
Mailing Address - Street 1:5920 N SAUGANASH LN
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6044
Mailing Address - Country:US
Mailing Address - Phone:773-685-4993
Mailing Address - Fax:773-685-6744
Practice Address - Street 1:10415 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1931
Practice Address - Country:US
Practice Address - Phone:708-430-5993
Practice Address - Fax:708-430-5476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1673724OtherBCBS PROVIDER #
IL1673724OtherBCBS PROVIDER #