Provider Demographics
NPI:1871578625
Name:MARLIN C HOOVER PHD PC
Entity type:Organization
Organization Name:MARLIN C HOOVER PHD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLIN
Authorized Official - Middle Name:COPPOCK
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:708-429-6999
Mailing Address - Street 1:16325 HARLEM AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2509
Mailing Address - Country:US
Mailing Address - Phone:708-429-6999
Mailing Address - Fax:708-429-6909
Practice Address - Street 1:16325 HARLEM AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2509
Practice Address - Country:US
Practice Address - Phone:708-429-6999
Practice Address - Fax:708-429-6909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL944251Medicare ID - Type Unspecified