Healthcare Provider Details

I. General information

NPI: 1366999781
Provider Name (Legal Business Name): CENTER FOR PSYCHOLOGICAL WELLNESS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W 99TH ST
OAK LAWN IL
60453-3506
US

IV. Provider business mailing address

4200 W 99TH ST
OAK LAWN IL
60453-3506
US

V. Phone/Fax

Practice location:
  • Phone: 708-655-6721
  • Fax: 312-782-7897
Mailing address:
  • Phone: 708-655-6721
  • Fax: 312-782-7897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180007148
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: KATE PALUSZEK
Title or Position: PRESIDENT
Credential: M.A., LCPC
Phone: 708-655-6721