DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: PSYCHOLOGY SPECIALISTS LTD

MEDICARE: PSYCHOLOGY SPECIALISTS LTD
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
1101Y00000XCounselor180-005747IL
2101Y00000XCounselor180-005332IL
3103TC0700XClinical Psychologist071-005708IL
4103TC0700XClinical Psychologist071-006980IL
51041C0700XClinical Social Worker149011166IL
6103TC0700XClinical Psychologist071-006198IL

General Provider Information

NPI Number : 1053368605
Entity Type Code : Organization
Provider Name (Legal Business Name) : PSYCHOLOGY SPECIALISTS LTD
Provider Business Mailing Address
First Line : 808 S ELDORADO RD STE 102
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61704-6075
Country : US
Telephone Number : 888-428-7890
Fax Number :
Provider Business Practice Location Address
First Line : 808 S ELDORADO RD STE 102
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61704-6075
Country : US
Telephone Number : 888-428-7890
Fax Number :
Authorized Official
Title or Position : VP OF OPERATIONS
Name : ADAM RUSSO
Credential :
Telephone Number : 888-428-7890
Provider Enumeration Date : 05/28/2006
Last Update Date : 09/26/2022

Similar Medicare Providers

1588008122 — MS. MICHELE M CARROLL L.C.S.W.
Practice Location Address:
808 S ELDORADO RD STE 102
BLOOMINGTON, IL
61704-6075
Practice Phone: 309-706-3190
Practice Fax:
1871782805 — KATHLEEN BACKUS MA, LCPC
Practice Location Address:
808 S ELDORADO RD STE 102
BLOOMINGTON, IL
61704-6075
Practice Phone: 309-212-6007
Practice Fax:
1780969816 — SARAH CAIN LCSW
Practice Location Address:
808 S ELDORADO RD STE 102
BLOOMINGTON, IL
61704-6075
Practice Phone: 309-706-3190
Practice Fax: 309-588-4115
1760757843 — MR. BRITAIN DUNAWAY MAC, LCPC
Practice Location Address:
808 S ELDORADO RD STE 102
BLOOMINGTON, IL
61704-6075
Practice Phone: 309-706-3190
Practice Fax: 309-588-4115
1467902130 — CHERYL RENEE CARTER PSYD
Practice Location Address:
808 S ELDORADO RD STE 102
BLOOMINGTON, IL
61704-6075
Practice Phone: 309-706-3190
Practice Fax: 309-588-4115
1255853396 — ATHENA DACANAY PSYD
Practice Location Address:
808 S ELDORADO RD STE 102
BLOOMINGTON, IL
61704-6075
Practice Phone: 309-706-3190
Practice Fax: 309-706-3190

Directions to “PSYCHOLOGY SPECIALISTS LTD ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.