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General NPI Number Information
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NPI Number | 1669083002
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Entity Type | Organization
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Legal Business Name | SEARCY PEDIATRIC AND ADOLESCENT BEHAVIORAL HEALTHCARE, LLC
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Dates
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Enumeration Date | 08/10/2020
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Last Update Date | 08/10/2020
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Provider Practice Location Address
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Address Line | 1 E ERIE ST STE 525
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City | CHICAGO
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State | IL
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Zip | 60611-2980
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Country | US
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Telephone | 312-471-3758
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Fax |
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Provider Business Mailing Address
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Address Line | 1910 S INDIANA AVE APT 219
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City | CHICAGO
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State | IL
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Zip | 60616-2915
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Country | US
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Telephone | 601-454-2082
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Fax |
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Authorized Official
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Title or Position | CHILD/PEDIATRIC PSYCHOLOGIST
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Name | DR. JASMIN S. SEARCY
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Credential | PH.D.
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Telephone | 601-454-2082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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