Healthcare Provider Details

I. General information

NPI: 1306888003
Provider Name (Legal Business Name): THE PERSONAL DEVELOPMENT GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 W NORTH AVE
CHICAGO IL
60610-1117
US

IV. Provider business mailing address

PO BOX 5126
EVANSTON IL
60204-5126
US

V. Phone/Fax

Practice location:
  • Phone: 773-635-4000
  • Fax: 773-635-4000
Mailing address:
  • Phone: 847-686-4000
  • Fax: 847-686-4000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. GREGORY CRISENBERY SCOTT CRISENBERY
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 847-686-4000