Healthcare Provider Details

I. General information

NPI: 1386041796
Provider Name (Legal Business Name): CHICAGO PSYCHOLOGICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 11/15/2020
Certification Date: 11/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 BREAKERS DR APT 329
OLYMPIA FIELDS IL
60461-1063
US

IV. Provider business mailing address

3633 BREAKERS DR APT 329
OLYMPIA FIELDS IL
60461-1063
US

V. Phone/Fax

Practice location:
  • Phone: 773-263-8855
  • Fax:
Mailing address:
  • Phone: 773-263-8855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number071001927
License Number StateIL

VIII. Authorized Official

Name: DR. JOHN B HOUCK
Title or Position: PRESIDENT
Credential: LICENSED CLINICAL PS
Phone: 773-263-8855