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General NPI Number Information
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NPI Number | 1194804526
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Entity Type | Organization
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Legal Business Name | GROUP FOR PSYCHOLOGICAL SERVICES LTD
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Dates
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Enumeration Date | 11/05/2006
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Last Update Date | 01/31/2012
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Provider Practice Location Address
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Address Line | 405 N WABASH AVE SUITE 606
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City | CHICAGO
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State | IL
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Zip | 60611-3591
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Country | US
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Telephone | 312-222-9797
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Fax |
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Provider Business Mailing Address
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Address Line | 2306 RIDGE AVE
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City | EVANSTON
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State | IL
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Zip | 60201-2617
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Country | US
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Telephone | 847-328-2573
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. RALPH LEVINSON
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Credential | PHD
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Telephone | 312-222-9797
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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 | 071-3208
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License Number State | IL
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