Healthcare Provider Details

I. General information

NPI: 1265549901
Provider Name (Legal Business Name): PSYCHEALTH, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 DAVIS ST
EVANSTON IL
60201-3605
US

IV. Provider business mailing address

922 DAVIS ST
EVANSTON IL
60201-3605
US

V. Phone/Fax

Practice location:
  • Phone: 847-864-4961
  • Fax: 847-864-9930
Mailing address:
  • Phone: 847-864-4961
  • Fax: 847-864-9930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateIL

VIII. Authorized Official

Name: JANET MARIE OBRIEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 847-864-4961