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General NPI Number Information
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NPI Number | 1093088676
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Entity Type | Organization
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Legal Business Name | JAL PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 02/13/2012
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 60 ORLAND SQUARE DR STE 203
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City | ORLAND PARK
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State | IL
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Zip | 60462-6523
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Country | US
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Telephone | 708-364-7046
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Fax | 708-364-7048
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Provider Business Mailing Address
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Address Line | 60 ORLAND SQUARE DR STE 203
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City | ORLAND PARK
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State | IL
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Zip | 60462-6523
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Country | US
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Telephone | 708-364-7046
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Fax | 708-364-7048
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JULIE ANN LEONARD
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Credential | PSYD
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Telephone | 708-364-7046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 071006856
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 071006856
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License Number State | IL
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