| Integrative Psyche Services, S.c. | |
|
326 W 64th St Chicago IL 60621-3114 | |
| (773) 962-4016 | |
| (773) 483-0411 |
| Full Name | Integrative Psyche Services, S.c. |
|---|---|
| Speciality | Psychologist |
| Location | 326 W 64th St, Chicago, Illinois |
| Authorized Official Name and Position | David Paul Smith (CEO/PRESIDENT) |
| Authorized Official Contact | 7739624016 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrative Psyche Services, S.c. 1454 E 56th St Chicago IL 60637-1866 Ph: (773) 962-4016 | Integrative Psyche Services, S.c. 326 W 64th St Chicago IL 60621-3114 Ph: (773) 962-4016 |
| NPI Number | 1619113396 |
|---|---|
| Provider Enumeration Date | 12/30/2008 |
| Last Update Date | 12/30/2008 |
| Medicare PECOS PAC ID | 8224195656 |
|---|---|
| Medicare Enrollment ID | O20090330000218 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619113396 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071006030 (Illinois) | Primary |
| Provider Name | David P Smith |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386711950 PECOS PAC ID: 3678558178 Enrollment ID: I20040621000105 |
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