=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831211580
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSYCHOLOGY SERVICES, INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2007
-----------------------------------------------------
Last Update Date | 07/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15040 S RAVINIA AVE SUITE 49
-----------------------------------------------------
City | ORLAND PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60462-3194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-349-4455
-----------------------------------------------------
Fax | 708-349-6448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15040 S RAVINIA AVE SUITE 49
-----------------------------------------------------
City | ORLAND PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60462-3194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-349-4455
-----------------------------------------------------
Fax | 708-349-6448
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | MS. MARY ANN KARSTENS
-----------------------------------------------------
Credential | LCSW, MA
-----------------------------------------------------
Telephone | 708-349-4455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 149-005827
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------