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General NPI Number Information
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NPI Number | 1336260272
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC SERVICES ASSOCIATES, LTD.
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 18861 90TH AVENUE SUITE C
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City | MOKENA
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State | IL
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Zip | 60448-8371
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Country | US
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Telephone | 708-422-3680
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Fax |
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Provider Business Mailing Address
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Address Line | 18861 90TH AVE STE C
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City | MOKENA
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State | IL
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Zip | 60448-8178
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Country | US
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Telephone | 708-422-3680
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. CHARLENE CROTTY
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Credential |
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Telephone | 708-422-3680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180002382
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License Number State | IL
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