Provider Demographics
NPI:1144431396
Name:OTTO, CHRISTIAN J (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:J
Last Name:OTTO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 S FAIRVIEW AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4033
Mailing Address - Country:US
Mailing Address - Phone:312-933-7549
Mailing Address - Fax:312-873-4738
Practice Address - Street 1:9 S FAIRVIEW AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4033
Practice Address - Country:US
Practice Address - Phone:312-933-7549
Practice Address - Fax:312-873-4738
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-26
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003609101YM0800X
IL166-000438106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist