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General NPI Number Information
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NPI Number | 1730605577
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Entity Type | Organization
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Legal Business Name | JUBY CLINICAL SERVICES, LLC
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 04/28/2019
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Provider Practice Location Address
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Address Line | 825 N CASS AVE STE 112
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City | WESTMONT
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State | IL
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Zip | 60559
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Country | US
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Telephone | 708-529-9353
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Fax |
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Provider Business Mailing Address
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Address Line | 825 N CASS AVE STE 112
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City | WESTMONT
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State | IL
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Zip | 60559-6401
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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 | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. BETHANY JOY JUBY
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Credential | PSY.D.
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Telephone | 708-336-9285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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