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General NPI Number Information
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NPI Number | 1669643003
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Entity Type | Organization
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Legal Business Name | OAK FOREST PSYCHOLOGICAL SERVICE, P.C.
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 133 MOHAWK DR
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1349
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Country | US
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Telephone | 815-937-4790
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Fax |
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Provider Business Mailing Address
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Address Line | 6502 JOLIET RD
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City | COUNTRYSIDE
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State | IL
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Zip | 60525-4682
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Country | US
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Telephone | 708-215-8400
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Fax | 708-215-8410
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SAMIRA SWEIS
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Credential |
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Telephone | 708-215-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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