MEDICARE: DR. JAMIE RILEY, PSYCHOTHERAPY PRACTICE, 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	:	1376173831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JAMIE RILEY, PSYCHOTHERAPY PRACTICE, LLC

Provider Business Mailing Address
First Line	:	2015 S ARLINGTON HEIGHTS RD STE 110
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-4150
Country	:	US
Telephone Number	:	708-601-1205
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 S ARLINGTON HEIGHTS RD STE 110
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-4150
Country	:	US
Telephone Number	:	708-601-1205
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL PSYCHOLOGIST
Name	:	DR. JAMIE RILEY
Credential	:	PSYD
Telephone Number	:	708-601-1205

Provider Enumeration Date	:	01/23/2020
Last Update Date	:	07/15/2020

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