MEDICARE: PEETINC CLINICAL AND CONSULTING SERVICES PLLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1598470742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEETINC CLINICAL AND CONSULTING SERVICES PLLC

Provider Business Mailing Address
First Line	:	2220 S KEDVALE AVE FL 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-2812
Country	:	US
Telephone Number	:	312-785-2487
Fax Number	:

Provider Business Practice Location Address
First Line	:	2220 S KEDVALE AVE FL 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-2812
Country	:	US
Telephone Number	:	312-785-2487
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER/CEO
Name	:	DR. RUBY COROLYN PEET
Credential	:	LCSW
Telephone Number	:	312-785-2487

Provider Enumeration Date	:	01/20/2023
Last Update Date	:	01/20/2023

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