NPIMap

Organization Active NPI

Emotion Management Program LLC

Doing business as Emotion Management Program

  • Clinical Psychologist
  • Orland Park, IL
National Provider Identifier
1083780522
Registry record updated Jul 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071005108 Issued in IL
Legal business name
EMOTION MANAGEMENT PROGRAM LLC
Doing business as
Emotion Management Program
Practice address
1800 Ravinia PL
Orland Park, IL 60462-3761
Phone
(708) 403-7570
Fax
(708) 403-7546
NPI assigned
Nov 27, 2006
Last updated
Jul 30, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Eugene Paul Holmes, PSY.D.NPI 1790861664
Title
Managing Partner
Phone
(708) 403-7580

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 180000522 IL
Clinical Psychologist 103TC0700X 071005108 IL Primary

Addresses

Primary practice location

1800 Ravinia PL
Orland Park, IL 60462-3761

Mailing address

PO Box 747
Blue Island, IL 60406-0747
Phone (708) 403-7570

Other identifiers 2

IdentifierTypeStateIssuer
01634764OtherILBCBSIL PPO
279826OtherILMAGELLAN

Other names 1

  • Emotion Management Program Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070316000336 IL Part B Supplier - Clinic/Group Practice 8628171360 Receives reassigned benefits from 5 practitioners
Practice locations: Orland Park, IL

National Provider Directory

National Provider Directory

Locations

1800 Ravinia Pl
Orland Park, IL 60462
Phone (708) 403-7570

7224 Arbor Dr
Tinley Park, IL 60477
Phone (708) 342-1742

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280448000000",
    "number": "1083780522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 747",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604060747",
            "telephone_number": "708-403-7570",
            "fax_number": "708-403-7546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 RAVINIA PL",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604623761",
            "telephone_number": "708-403-7570",
            "fax_number": "708-403-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMOTION MANAGEMENT PROGRAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2010-07-30",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "708-403-7580",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180000522",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071005108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSIL PPO",
            "identifier": "01634764",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "279826",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emotion Management Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orland Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.