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General NPI Number Information
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NPI Number | 1386604577
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Entity Type | Organization
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Legal Business Name | CENTER FOR PSYCHOLOGICAL SERVICES - OAK LAWN LTD
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 10735 S CICERO AVE SUITE 208
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City | OAK LAWN
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State | IL
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Zip | 60453-5400
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Country | US
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Telephone | 708-424-0001
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Fax | 708-424-1394
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Provider Business Mailing Address
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Address Line | 10735 S CICERO AVE SUITE 208
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City | OAK LAWN
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State | IL
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Zip | 60453-5400
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Country | US
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Telephone | 708-424-0001
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Fax | 708-424-1394
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Authorized Official
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Title or Position | OWNER AND HEAD OF THE PRACTICE
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Name | DR. VICTORIA KOWALSKY WILLIAMS
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Credential | PSYD
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Telephone | 708-424-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 071 003598
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License Number State | IL
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