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General NPI Number Information
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NPI Number | 1093075301
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Entity Type | Organization
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Legal Business Name | PSYCYNERGY PSYCHOLOGICAL SERVICES PC
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/09/2017
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Provider Practice Location Address
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Address Line | 369 E SIBLEY BLVD SUITE A
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City | HARVEY
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State | IL
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Zip | 60426-2530
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Country | US
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Telephone | 888-205-5532
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Fax |
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Provider Business Mailing Address
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Address Line | 1337 S INDIANA PKWY
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City | CHICAGO
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State | IL
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Zip | 60605-2619
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Country | US
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Telephone | 773-671-0466
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO/SENIOR PARTNER
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Name | DR. JERRY L WEEMS
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Credential | PSY.D.
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Telephone | 773-671-0466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 180004026
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180004026
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 071006437
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number | 071006437
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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 | 071006437
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 071006437
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License Number State | IL
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Taxonomy #7
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 071006437
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License Number State | IL
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Taxonomy #8
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 180004026
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License Number State | IL
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Taxonomy #9
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 14013
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License Number State | IL
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