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General NPI Number Information
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NPI Number | 1104941798
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL WELLNESS CENTER, INC.
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1030 S LA GRANGE RD SUITE 8
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City | LA GRANGE
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State | IL
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Zip | 60525-2800
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Country | US
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Telephone | 708-352-2597
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Fax |
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Provider Business Mailing Address
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Address Line | 12632 ROYAL GORGE CT
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City | MOKENA
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State | IL
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Zip | 60448-1661
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Country | US
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Telephone | 708-369-2640
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Fax | 708-995-5058
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Authorized Official
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Title or Position | OWNER & PRESIDENT
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Name | DR. SUE SZUMIGALSKI
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Credential | PSY.D.
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Telephone | 708-369-2640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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License Number State | IL
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