Healthcare Provider Details

I. General information

NPI: 1871103838
Provider Name (Legal Business Name): LUKE TSENG PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 MANCHESTER RD STE 1510
WHEATON IL
60187-4561
US

IV. Provider business mailing address

0N461 SUNSET AVE
WEST CHICAGO IL
60185-3069
US

V. Phone/Fax

Practice location:
  • Phone: 630-653-1717
  • Fax:
Mailing address:
  • Phone: 217-417-4192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number108386
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071010597
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: