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General NPI Number Information
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NPI Number | 1295100485
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Entity Type | Organization
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Legal Business Name | PARKSIDE PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 12/14/2015
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 840 S WAUKEGAN RD STE 203
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City | LAKE FOREST
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State | IL
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Zip | 60045-2619
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Country | US
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Telephone | 847-420-5088
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Fax |
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Provider Business Mailing Address
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Address Line | 840 S WAUKEGAN RD STE 203
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City | LAKE FOREST
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State | IL
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Zip | 60045-2619
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Country | US
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Telephone | 847-420-5088
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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. PAUL SMILEY
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Credential | PSYD, ABPP
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Telephone | 847-420-5088
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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 | 071.007555
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License Number State | IL
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