| Patriot Self Defense | |
|
11516 183rd Pl Ste Ne Orland Park IL 60467-9473 | |
| (708) 717-6103 | |
| Not Available |
| Full Name | Patriot Self Defense |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 11516 183rd Pl Ste Ne, Orland Park, Illinois |
| Authorized Official Name and Position | Tracy Robinson (OWNER) |
| Authorized Official Contact | 7087176103 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Patriot Self Defense 11516 183rd Pl Ste Ne Orland Park IL 60467-9473 Ph: (708) 717-6103 | Patriot Self Defense 11516 183rd Pl Ste Ne Orland Park IL 60467-9473 Ph: (708) 717-6103 |
| NPI Number | 1750080313 |
|---|---|
| Provider Enumeration Date | 03/02/2023 |
| Last Update Date | 03/02/2023 |
| Certification Date | 03/02/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750080313 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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