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General NPI Number Information
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NPI Number | 1295007318
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Entity Type | Organization
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Legal Business Name | PALOS PSYCHOTHERAPY ASSOCIATES, LLC
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Dates
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Enumeration Date | 02/05/2012
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Last Update Date | 02/06/2012
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Provider Practice Location Address
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Address Line | 7330 W COLLEGE DR SUITE 202
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1157
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Country | US
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Telephone | 708-364-7272
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Fax |
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Provider Business Mailing Address
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Address Line | 7330 W COLLEGE DR SUITE 202
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1157
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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 | LCPC
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Name | PATRICIA RUECKHEIM
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Credential | LCPC
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Telephone | 708-364-7272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149010486
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License Number State | IL
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