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General NPI Number Information
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NPI Number | 1366022519
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Entity Type | Organization
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Legal Business Name | CK PSYCH PLLC
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Dates
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Enumeration Date | 04/12/2021
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Last Update Date | 07/15/2021
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Provider Practice Location Address
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Address Line | 10725 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-3217
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Country | US
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Telephone | 630-251-4346
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Fax |
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Provider Business Mailing Address
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Address Line | 1389 LILY CACHE LN
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City | BOLINGBROOK
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State | IL
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Zip | 60490-4502
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Country | US
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Telephone | 630-251-4346
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | CLAUDE L KING
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Credential | LCPC
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Telephone | 630-251-4346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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