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General NPI Number Information
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NPI Number | 1538850276
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Entity Type | Organization
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Legal Business Name | 312 PSYCH SERVICES PLLC
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Dates
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Enumeration Date | 05/15/2023
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 226 N CLINTON ST APT 321
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City | CHICAGO
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State | IL
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Zip | 60661-1184
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Country | US
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Telephone | 773-759-2036
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Fax |
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Provider Business Mailing Address
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Address Line | 917 W WASHINGTON BLVD UNIT 272
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City | CHICAGO
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State | IL
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Zip | 60607-2203
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Country | US
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Telephone | 312-248-3655
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALICIA ALI
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Credential | PSY.D.
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Telephone | 312-248-3655
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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 |
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License Number State |
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