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General NPI Number Information
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NPI Number | 1073188744
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Entity Type | Organization
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Legal Business Name | ILLINOIS PSYCH SERVICES PLLC
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 738 E DUNDEE RD
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City | PALATINE
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State | IL
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Zip | 60074-2858
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Country | US
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Telephone | 330-536-3746
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Fax | 330-267-4250
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Provider Business Mailing Address
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Address Line | 3593 MEDINA RD STE 181
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City | MEDINA
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State | OH
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Zip | 44256-8182
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Country | US
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Telephone | 330-536-3746
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Fax | 330-267-4250
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ROBERT SEAN RAE
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Credential | MD
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Telephone | 330-536-3746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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