Provider Demographics
NPI:1063061984
Name:PHYLLIS DAWSON, PSY.D., LLC
Entity type:Organization
Organization Name:PHYLLIS DAWSON, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:224-326-0025
Mailing Address - Street 1:666 DUNDEE RD STE 1302
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2736
Mailing Address - Country:US
Mailing Address - Phone:224-326-0025
Mailing Address - Fax:847-400-5828
Practice Address - Street 1:666 DUNDEE RD STE 1302
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2736
Practice Address - Country:US
Practice Address - Phone:224-326-0025
Practice Address - Fax:847-400-5828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)