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General NPI Number Information
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NPI Number | 1063497345
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Entity Type | Organization
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Legal Business Name | PALOS PSYCHIATRIC & RECOVERY INST LTD
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 7300 W COLLEGE DR 101
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1152
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Country | US
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Telephone | 708-448-8470
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Fax | 708-448-9651
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Provider Business Mailing Address
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Address Line | 7300 W COLLEGE DR SUITE 101
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1152
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Country | US
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Telephone | 708-448-8470
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Fax | 708-448-9651
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Authorized Official
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Title or Position | INS COORDINATOR
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Name | MRS. DALIA COLLAZO
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Credential |
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Telephone | 708-448-8470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 18000637
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State | IL
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