Healthcare Provider Details

I. General information

NPI: 1689620668
Provider Name (Legal Business Name): RIVERSIDE PSYCHIATRIC & COUNSELING P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7234 OGDEN AVE SUITE 3N
RIVERSIDE IL
60546-2269
US

IV. Provider business mailing address

1341 WARREN AVE
DOWNERS GROVE IL
60515-3437
US

V. Phone/Fax

Practice location:
  • Phone: 708-447-2277
  • Fax: 708-447-2274
Mailing address:
  • Phone: 630-719-5454
  • Fax: 630-719-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.002055
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number209.264171
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. TAHIR M. SHEIKH
Title or Position: DIRECTOR
Credential: M.D.
Phone: 630-719-5454