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General NPI Number Information
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NPI Number | 1194113357
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Entity Type | Organization
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Legal Business Name | CENTER FOR PSYCHOLOGY AND WELLNESS, P.C.
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 601 SKOKIE BLVD SUITE #LL-5D
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City | NORTHBROOK
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State | IL
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Zip | 60062-2851
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Country | US
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Telephone | 847-607-1589
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Fax |
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Provider Business Mailing Address
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Address Line | 601 SKOKIE BLVD SUITE #LL-5D
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City | NORTHBROOK
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State | IL
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Zip | 60062-2851
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANNA BASOV
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Credential | PSYD, LCPC
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Telephone | 847-607-1589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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