Healthcare Provider Details

I. General information

NPI: 1265487060
Provider Name (Legal Business Name): OAK FOREST PSYCHOLOGICAL SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6502 JOLIET RD
COUNTRYSIDE IL
60525-4682
US

IV. Provider business mailing address

6502 JOLIET RD FLOOR 2
COUNTRYSIDE IL
60525-4613
US

V. Phone/Fax

Practice location:
  • Phone: 708-215-8400
  • Fax: 708-215-8410
Mailing address:
  • Phone: 708-215-8400
  • Fax: 708-215-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KAREN NEKOLNY-SMITH
Title or Position: CLINICAL COORDINATOR
Credential:
Phone: 708-215-8400