=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326751405
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHAMSI PSYCHOLOGICAL SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2023
-----------------------------------------------------
Last Update Date | 11/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7627 LAKE ST STE 206 #A90
-----------------------------------------------------
City | RIVER FOREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60305-1878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-234-5644
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7627 LAKE ST STE 206 #A90
-----------------------------------------------------
City | RIVER FOREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60305-1878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-234-5644
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. TABISH SHAMSI
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 773-234-8349
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------