Healthcare Provider Details

I. General information

NPI: 1790620151
Provider Name (Legal Business Name): CHERYL H MCNALLY NCSP, I/ECMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 N RAVENSWOOD AVE STE 105
CHICAGO IL
60640-7569
US

IV. Provider business mailing address

2857 W WILSON AVE
CHICAGO IL
60625-3742
US

V. Phone/Fax

Practice location:
  • Phone: 312-899-6226
  • Fax:
Mailing address:
  • Phone: 773-771-2231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1841846
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: