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General NPI Number Information
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NPI Number | 1033267661
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Entity Type | Organization
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Legal Business Name | PRO PSYCH ASSOCIATES SC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/09/2012
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Provider Practice Location Address
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Address Line | 2604 DEMPSTER ST SUITE 307
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City | PARK RIDGE
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State | IL
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Zip | 60068-8412
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Country | US
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Telephone | 847-544-5102
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Fax | 847-544-5103
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Provider Business Mailing Address
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Address Line | 2604 DEMPSTER ST SUITE 307
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City | PARK RIDGE
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State | IL
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Zip | 60068-8412
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Country | US
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Telephone | 847-544-5102
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Fax | 847-544-5103
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OK RO HONG
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Credential | M.D.
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Telephone | 847-544-5102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-006314
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-006486
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036-073905
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License Number State | IL
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