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General NPI Number Information
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NPI Number | 1831594407
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Entity Type | Organization
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Legal Business Name | CENTER FOR PERSONAL GROWTH, PLLC
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Dates
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Enumeration Date | 10/25/2014
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Last Update Date | 02/24/2024
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Provider Practice Location Address
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Address Line | 640 E SAINT CHARLES RD STE 212
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City | CAROL STREAM
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State | IL
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Zip | 60188-2600
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Country | US
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Telephone | 630-791-0118
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Fax | 630-708-7654
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Provider Business Mailing Address
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Address Line | 640 E SAINT CHARLES RD STE 212
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City | CAROL STREAM
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State | IL
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Zip | 60188-2600
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Country | US
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Telephone | 630-791-0118
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Fax | 630-708-7654
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KIERA E LIEBICH
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Credential |
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Telephone | 630-791-0118
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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 | 071.008385
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.008385
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License Number State | IL
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