Healthcare Provider Details

I. General information

NPI: 1316122963
Provider Name (Legal Business Name): HELLER PSYCHOLOGICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E SUPERIOR ST 310
CHICAGO IL
60611-2507
US

IV. Provider business mailing address

1 E SUPERIOR ST STE 506
CHICAGO IL
60611-2593
US

V. Phone/Fax

Practice location:
  • Phone: 312-988-7792
  • Fax: 312-988-4040
Mailing address:
  • Phone: 847-410-9059
  • Fax: 312-988-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071002999
License Number StateIL

VIII. Authorized Official

Name: AMANDA GERBER
Title or Position: OWNER
Credential: PSYD
Phone: 847-410-9059