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General NPI Number Information
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NPI Number | 1912031659
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Entity Type | Organization
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Legal Business Name | WEST SUBURBAN PSYCHOLOGICAL SERVICES, LTD.
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 1809 NORTH MILL STREET SUITE G
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City | NAPERVILLE
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State | IL
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Zip | 60563
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Country | US
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Telephone | 630-585-0039
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Fax | 630-585-1491
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Provider Business Mailing Address
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Address Line | 1809 NORTH MILL STREET SUITE G
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City | NAPERVILLE
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State | IL
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Zip | 60563
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Country | US
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Telephone | 630-585-0039
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Fax | 630-585-1491
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Authorized Official
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Title or Position | OWNER
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Name | SAMUEL REST
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Credential | PH.D.
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Telephone | 630-585-0039
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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 |
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License Number State |
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