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General NPI Number Information
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NPI Number | 1316466857
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Entity Type | Organization
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Legal Business Name | ETHOS PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 09/15/2017
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 444 N NORTHWEST HWY STE 375
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City | PARK RIDGE
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State | IL
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Zip | 60068-3271
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Country | US
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Telephone | 917-403-4631
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Fax |
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Provider Business Mailing Address
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Address Line | 7903 LOWELL AVE
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City | SKOKIE
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State | IL
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Zip | 60076-3537
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Country | US
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Telephone | 917-403-4631
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JOHN ELIOT LEFFEL
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Credential | PSYD
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Telephone | 917-403-4631
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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 | 071008161
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License Number State | IL
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