Healthcare Provider Details

I. General information

NPI: 1386604577
Provider Name (Legal Business Name): CENTER FOR PSYCHOLOGICAL SERVICES - OAK LAWN LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 04/17/2013
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: 708-424-1394
Mailing address:
  • Phone: 708-424-0001
  • Fax: 708-424-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number071 003598
License Number StateIL

VIII. Authorized Official

Name: DR. VICTORIA KOWALSKY WILLIAMS
Title or Position: OWNER AND HEAD OF THE PRACTICE
Credential: PSYD
Phone: 708-424-0001