Healthcare Provider Details

I. General information

NPI: 1437860343
Provider Name (Legal Business Name): COURTNEY WELLS, PHD LLC DBA PIVOT PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 N RAVENSWOOD AVE STE 201
CHICAGO IL
60640-7573
US

IV. Provider business mailing address

4611 N RAVENSWOOD AVE STE 201
CHICAGO IL
60640-7573
US

V. Phone/Fax

Practice location:
  • Phone: 312-868-0163
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. COURTNEY WELLS
Title or Position: OWNER/PSYCHOLOGIST
Credential: PH.D.
Phone: 312-868-0163