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General NPI Number Information
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NPI Number | 1679711642
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Entity Type | Organization
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Legal Business Name | OCD TREATMENT CENTER, LLC
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Dates
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Enumeration Date | 01/29/2009
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Last Update Date | 01/29/2009
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Provider Practice Location Address
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Address Line | 1130 W CORNELIA AVE APT D
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City | CHICAGO
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State | IL
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Zip | 60657-1549
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Country | US
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Telephone | 773-220-1995
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Fax |
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Provider Business Mailing Address
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Address Line | 1130 W CORNELIA AVE APT D
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City | CHICAGO
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State | IL
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Zip | 60657-1549
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | KEVIN L GYOERKOE
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Credential | PSY.D.
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Telephone | 773-220-1995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.006130
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License Number State | IL
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