MEDICARE: THE RESILIENCE CENTER, 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	071008680	IL

General Provider Information

NPI Number	:	1205336088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE RESILIENCE CENTER, LLC

Provider Business Mailing Address
First Line	:	30 N MICHIGAN AVE STE 1530
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-3670
Country	:	US
Telephone Number	:	214-603-7297
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 N MICHIGAN AVE STE 1530
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-3670
Country	:	US
Telephone Number	:	214-603-7297
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. ALEXIS SILAS
Credential	:	PSY.D.
Telephone Number	:	214-603-7297

Provider Enumeration Date	:	02/18/2018
Last Update Date	:	02/18/2018

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