Basic Information
| Provider Information | |||||||||
| NPI: | 1306914015 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALINA | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22285 N PEPPER RD | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | LAKE BARRINGTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600102538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478826604 | ||||||||
| FaxNumber: | 8478826228 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 N WESTMORELAND RD FL 3 | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600451658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475356615 | ||||||||
| FaxNumber: | 4753576558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 09/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 071005817 | IL | N | Behavioral Health & Social Service Providers | Counselor | 103T00000X | 071-005817 | IL | N | Behavioral Health & Social Service Providers | Psychologist | 103G00000X | 071-005817 | IL | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.