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NPI Code Detail

MEDICARE: JOLIET CENTER FOR CLINICAL RESEARCH, INC

MEDICARE: JOLIET CENTER FOR CLINICAL RESEARCH, INC
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
1103TC0700XClinical Psychologist
22084P0800XPsychiatry Physician
3364SP0808XPsychiatric/Mental Health Clinical Nurse Specialist
4101YP2500XProfessional Counselor
5261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1760647226
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOLIET CENTER FOR CLINICAL RESEARCH, INC
Provider Business Mailing Address
First Line : 210 N HAMMES AVE STE 205
Second Line :
City : JOLIET
State : IL
Zip : 60435-8139
Country : US
Telephone Number : 815-729-7790
Fax Number : 815-725-8144
Provider Business Practice Location Address
First Line : 210 N HAMMES AVE STE 205
Second Line :
City : JOLIET
State : IL
Zip : 60435-8139
Country : US
Telephone Number : 815-729-7790
Fax Number : 815-725-8144
Authorized Official
Title or Position : OFFICE MANAGER
Name : DIANE L HARRIS
Credential :
Telephone Number : 815-729-7790
Provider Enumeration Date : 07/24/2008
Last Update Date : 03/24/2026

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