Healthcare Provider Details

I. General information

NPI: 1821984568
Provider Name (Legal Business Name): THE TRAUMA & ANXIETY PSYCHOLOGICAL SERVICES CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 W BALMORAL AVE APT 1E
CHICAGO IL
60640-1720
US

IV. Provider business mailing address

2501 CHATHAM RD STE 8366
SPRINGFIELD IL
62704-4188
US

V. Phone/Fax

Practice location:
  • Phone: 773-379-8129
  • Fax:
Mailing address:
  • Phone: 773-379-8129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEREMY SAENZ
Title or Position: PSYCHOLOGIST & SOLE PROPRIETOR
Credential: PH.D.
Phone: 773-379-8129