=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134560881
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R H FIFE AND ASSOCIATES - BRIGHT FUTURES - R HALL PSYD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2013
-----------------------------------------------------
Last Update Date | 07/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14315 108TH AVE SUITE 220A
-----------------------------------------------------
City | ORLAND PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60467-5700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-669-3311
-----------------------------------------------------
Fax | 708-403-6796
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 613
-----------------------------------------------------
City | CHANNAHON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60410-0613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-521-1889
-----------------------------------------------------
Fax | 815-521-1889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | REBECCA HALL FIFE
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 708-669-3311
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 071007445
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------