MEDICARE: DOWNEY THERAPEUTIC SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1023580123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOWNEY THERAPEUTIC SERVICES LLC

Provider Business Mailing Address
First Line	:	323 E WACKER DR UNIT 207
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-5282
Country	:	US
Telephone Number	:	310-498-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	323 E WACKER DR UNIT 207
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-5282
Country	:	US
Telephone Number	:	310-498-9700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KEISHA DOWNEY
Credential	:
Telephone Number	:	310-498-9700

Provider Enumeration Date	:	12/30/2018
Last Update Date	:	04/07/2026

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