Healthcare Provider Details

I. General information

NPI: 1497082770
Provider Name (Legal Business Name): VALLEY PSYCHIATRY AND COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2009
Last Update Date: 11/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MARKET ST SUITE 14
ELGIN IL
60123-5093
US

IV. Provider business mailing address

75 MARKET ST SUITE 14
ELGIN IL
60123-5093
US

V. Phone/Fax

Practice location:
  • Phone: 847-697-6290
  • Fax: 847-697-0252
Mailing address:
  • Phone: 847-697-6290
  • Fax: 847-697-0252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036-119726
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036-119726
License Number StateIL

VIII. Authorized Official

Name: DR. SYED WALIUDDIN
Title or Position: MANAGER
Credential: M.D.
Phone: 847-697-6290