Healthcare Provider Details

I. General information

NPI: 1245281583
Provider Name (Legal Business Name): PSYCHOLOGICAL SERVICES OF CENTRAL ILLINOIS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 GREENBRIAR DR SUITE B-1
SPRINGFIELD IL
62704-6425
US

IV. Provider business mailing address

2921 GREENBRIAR DR SUITE B-1
SPRINGFIELD IL
62704-6425
US

V. Phone/Fax

Practice location:
  • Phone: 217-546-3118
  • Fax: 217-546-3184
Mailing address:
  • Phone: 217-546-3118
  • Fax: 217-546-3184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. RICHARD E. DIMOND
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 217-546-3118