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General NPI Number Information
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NPI Number | 1144971581
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Entity Type | Organization
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Legal Business Name | ANXIETY CENTERS OF ILLINOIS
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 600 DAKOTA ST.
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City | CRYSTAL LAKE
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State | IL
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Zip | 60012
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Country | US
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Telephone | 847-854-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 1144 RIDGEWOOD CIRCLE
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City | LAKE IN THE HILLS
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State | IL
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Zip | 60156
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Country | US
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Telephone | 847-854-8200
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Fax |
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Authorized Official
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Title or Position | PRESIDENT-ACI
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Name | DR. PATRICK B MCGRATH
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Credential | PH.D.
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Telephone | 847-854-8200
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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 |
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License Number State |
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