Healthcare Provider Details

I. General information

NPI: 1285874966
Provider Name (Legal Business Name): CENTER FOR PSYCHOLOGICAL SERVICES,LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10735 S CICERO AVE SUITE 208
OAK LAWN IL
60453-5400
US

IV. Provider business mailing address

10735 S CICERO AVE SUITE 208
OAK LAWN IL
60453-5400
US

V. Phone/Fax

Practice location:
  • Phone: 708-424-0001
  • Fax:
Mailing address:
  • Phone: 708-424-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178006183
License Number StateIL

VIII. Authorized Official

Name: MRS. ALLISON JOY FINE
Title or Position: THERAPIST
Credential: MS
Phone: 708-424-0001