Koller, Terrence James
Koller, Terrence James is an sole proprietor health care provider with primary practice located at 1740 Ridge Ave 200 C, Evanston IL 60201-5918. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Koller, Terrence James can be contacted via phone (847) 475-5551.Contact Information
Primary practice address
1740 Ridge Ave 200 C
Evanston IL 60201-5918
Phone: (847) 475-5551
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 071002716 | Illinois |
Profile Details
| NPI number | 1487647715 |
|---|---|
| LBN Legal business name | Koller, Terrence James |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 23rd, 2005 |
| Last updated | Oct 7th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487647715 | NPPES |
| Illinois | Other | 01672636 | BLUE CROSS/BLUE SHIELD |
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