| None | |
|
2555 Lincoln Hwy Suite # 108c Olympia Fields IL 60461-1936 | |
| (708) 983-8030 | |
| (708) 283-2544 |
| Full Name | None |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 2555 Lincoln Hwy, Olympia Fields, Illinois |
| Authorized Official Name and Position | Mary A Lee (CEO) |
| Authorized Official Contact | 7089838030 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| None 4710 Lincoln Hwy Suite # 167 Matteson IL 60443-2316 Ph: (708) 983-8030 | None 2555 Lincoln Hwy Suite # 108c Olympia Fields IL 60461-1936 Ph: (708) 983-8030 |
| NPI Number | 1801919691 |
|---|---|
| Provider Enumeration Date | 04/09/2007 |
| Last Update Date | 01/17/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801919691 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071004127 (Illinois) | Primary |
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