| Advance Potential Psychological Services, Llc | |
|
2007 W Greenleaf Ave Chicago IL 60645-3509 | |
| (773) 512-8813 | |
| (773) 743-7696 |
| Full Name | Advance Potential Psychological Services, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2007 W Greenleaf Ave, Chicago, Illinois |
| Authorized Official Name and Position | Glenn August Sevier (CEO/EXCUTIVE PRESIDENT) |
| Authorized Official Contact | 7735128813 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advance Potential Psychological Services, Llc 2007 W Greenleaf Ave Chicago IL 60645-3509 Ph: (773) 512-8813 | Advance Potential Psychological Services, Llc 2007 W Greenleaf Ave Chicago IL 60645-3509 Ph: (773) 512-8813 |
| NPI Number | 1922369941 |
|---|---|
| Provider Enumeration Date | 06/06/2012 |
| Last Update Date | 07/31/2013 |
| Medicare PECOS PAC ID | 7315188661 |
|---|---|
| Medicare Enrollment ID | O20130729000685 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922369941 | NPI | - | NPPES |
| 492722592001 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Glenn Sevier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669784989 PECOS PAC ID: 3779772777 Enrollment ID: I20110106000387 |
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