Healthcare Provider Details

I. General information

NPI: 1407285638
Provider Name (Legal Business Name): SPECIALIZED ASSESSING SYSTEMS INSTITUTE, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8251 S RHODES AVE 4500 S MICHIGAN
CHICAGO IL
60619-5005
US

IV. Provider business mailing address

8251 S RHODES AVE
CHICAGO IL
60619-5005
US

V. Phone/Fax

Practice location:
  • Phone: 773-818-9607
  • Fax:
Mailing address:
  • Phone: 773-818-9607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number149004694
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number149004694
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number149004694
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number149004694
License Number StateIL

VIII. Authorized Official

Name: MR. ELWOOD P NYTHER
Title or Position: PRESIDENT/CEO
Credential: LCSW
Phone: 773-818-9607