| Psychology Center P.c. | |
|
10343 S Western Avenue Chicago IL 60643-2410 | |
| (773) 238-2828 | |
| (708) 974-3845 |
| Full Name | Psychology Center P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 10343 S Western Avenue, Chicago, Illinois |
| Authorized Official Name and Position | James T Davenport (OWNER/PROVIDER) |
| Authorized Official Contact | 7089744274 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychology Center P.c. 10713 W Doric Circle Palos Hills IL 60465-2220 Ph: (773) 238-2828 | Psychology Center P.c. 10343 S Western Avenue Chicago IL 60643-2410 Ph: (773) 238-2828 |
| NPI Number | 1396735361 |
|---|---|
| Provider Enumeration Date | 10/21/2005 |
| Last Update Date | 01/28/2015 |
| Medicare PECOS PAC ID | 0840454575 |
|---|---|
| Medicare Enrollment ID | O20120611000036 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396735361 | NPI | - | NPPES |
| 345365834001 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 060005211 (Illinois) | Secondary |
| 103TC0700X | Psychologist - Clinical | 071003666 (Illinois) | Primary |
| Provider Name | James Davenport |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881683969 PECOS PAC ID: 7113826769 Enrollment ID: I20040102000749 |
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