Healthcare Provider Details

I. General information

NPI: 1033301189
Provider Name (Legal Business Name): PSYCHIATRIC SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BATSON ST SUITE E
NEW LENOX IL
60451
US

IV. Provider business mailing address

701 MISTY CREEK DR
NEW LENOX IL
60451
US

V. Phone/Fax

Practice location:
  • Phone: 815-485-2885
  • Fax: 815-485-2185
Mailing address:
  • Phone: 815-485-2163
  • Fax: 815-485-6567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. THOMAS FRANCIS LELIO
Title or Position: OWNER
Credential: MD
Phone: 815-485-2163