Provider Demographics
NPI:1831198837
Name:SCHEVERS, THOMAS J (PHD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:SCHEVERS
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 1:1100 COUGAR TRL
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-6057
Mailing Address - Country:US
Mailing Address - Phone:815-444-0446
Mailing Address - Fax:815-444-0446
Practice Address - Street 1:4405 THREE OAKS ROAD
Practice Address - Street 2:UNIT B
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014
Practice Address - Country:US
Practice Address - Phone:815-444-0446
Practice Address - Fax:815-444-0446
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05619771OtherBCBS
IL955971Medicare ID - Type Unspecified
ILR21674Medicare UPIN