Healthcare Provider Details

I. General information

NPI: 1649778994
Provider Name (Legal Business Name): GRYZBEK THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1979 N MILL ST STE 204
NAPERVILLE IL
60563-8472
US

IV. Provider business mailing address

1979 N MILL ST STE 204
NAPERVILLE IL
60563-8472
US

V. Phone/Fax

Practice location:
  • Phone: 630-474-1171
  • Fax: 833-218-8811
Mailing address:
  • Phone: 630-474-1171
  • Fax: 833-218-8811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number071.009076
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number071.009076
License Number StateIL

VIII. Authorized Official

Name: DR. JOSEPH GRYZBEK
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 630-474-1171