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:
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Health care specialties

SpecialtyCodeLicense #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 15 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487647715 NPPES
Illinois Other 01672636 BLUE CROSS/BLUE SHIELD

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