Provider Demographics
NPI:1992957757
Name:DR. ANN DOURLET MOTT, P.C.
Entity type:Organization
Organization Name:DR. ANN DOURLET MOTT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:DOURLET
Authorized Official - Last Name:MOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-604-4140
Mailing Address - Street 1:800 E NORTHWEST HWY STE 407
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-6519
Mailing Address - Country:US
Mailing Address - Phone:847-604-4140
Mailing Address - Fax:
Practice Address - Street 1:800 E NORTHWEST HWY STE 407
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-6519
Practice Address - Country:US
Practice Address - Phone:847-604-4140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004004103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1013016161OtherINDIVIDUAL NPI
IL1013016161OtherINDIVIDUAL NPI