Healthcare Provider Details

I. General information

NPI: 1366022519
Provider Name (Legal Business Name): CK PSYCH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10725 S WESTERN AVE
CHICAGO IL
60643-3217
US

IV. Provider business mailing address

1389 LILY CACHE LN
BOLINGBROOK IL
60490-4502
US

V. Phone/Fax

Practice location:
  • Phone: 630-251-4346
  • Fax:
Mailing address:
  • Phone: 630-251-4346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CLAUDE L KING
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCPC
Phone: 630-251-4346