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General NPI Number Information
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NPI Number | 1144602368
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Entity Type | Organization
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Legal Business Name | PROPSY, INC.
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Dates
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Enumeration Date | 06/24/2015
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Last Update Date | 07/20/2016
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Provider Practice Location Address
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Address Line | 4633 N WESTERN AVE SUITE 204
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City | CHICAGO
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State | IL
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Zip | 60625-2181
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Country | US
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Telephone | 733-800-9164
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Fax |
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Provider Business Mailing Address
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Address Line | 4880 N CLARK ST APT 4A
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City | CHICAGO
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State | IL
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Zip | 60640-7773
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Country | US
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Telephone | 733-800-9164
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PSYCHOLOGIST
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Name | DR. KUANWU LIN
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Credential | PSY.D.
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Telephone | 773-800-9164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071007108
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License Number State | IL
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