Healthcare Provider Details

I. General information

NPI: 1104504844
Provider Name (Legal Business Name): HALEY M SIMS PSYD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W SUPERIOR ST STE 315
CHICAGO IL
60654-3593
US

IV. Provider business mailing address

1 E DELAWARE PL APT 12G
CHICAGO IL
60611-4970
US

V. Phone/Fax

Practice location:
  • Phone: 812-340-4219
  • Fax:
Mailing address:
  • Phone: 812-340-4219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: HALEY SIMS
Title or Position: OWNER
Credential: LCP
Phone: 812-340-4219