MEDICARE: THE CHICAGO SCHOOL OF PROFESSIONAL PSYCHOLOGY

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	261Q00000X	Clinic/Center
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1336468909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CHICAGO SCHOOL OF PROFESSIONAL PSYCHOLOGY

Provider Business Mailing Address
First Line	:	325 N WELLS ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-7024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 MERCHANDISE MART
Second Line	:	SUITE 442
City	:	CHICAGO
State	:	IL
Zip	:	60654-1103
Country	:	US
Telephone Number	:	312-467-2535
Fax Number	:

Authorized Official
Title or Position	:	CAMPUS DEAN
Name	:	MARGARET MARTYN
Credential	:	PH.D., MBA
Telephone Number	:	312-467-2331

Provider Enumeration Date	:	05/21/2010
Last Update Date	:	12/14/2018

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