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General NPI Number Information
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NPI Number | 1235551060
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Entity Type | Organization
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Legal Business Name | CRAIG CASTRO PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 01/14/2014
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 1800 NATIONS DR SUITE 208
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City | GURNEE
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State | IL
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Zip | 60031-9168
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Country | US
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Telephone | 773-456-3156
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Fax |
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Provider Business Mailing Address
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Address Line | 7N699 WAGONTIRE RD
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City | ST CHARLES
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State | IL
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Zip | 60175-6620
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Country | US
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Telephone | 773-456-3156
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CHIEF PSYCHOLOGIST
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Name | DR. DOUGLAS NEAL CRAIG II
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Credential | PSY.D.
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Telephone | 773-456-3156
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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 | 071-007815
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License Number State | IL
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