Provider Demographics
NPI:1063561272
Name:ASSOCIATES IN CLINICAL PSYCHOLOGY PC
Entity type:Organization
Organization Name:ASSOCIATES IN CLINICAL PSYCHOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ZACKHELM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-355-1433
Mailing Address - Street 1:1801 SHORE ACRES RD
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044
Mailing Address - Country:US
Mailing Address - Phone:630-355-1433
Mailing Address - Fax:847-295-9841
Practice Address - Street 1:317 WEST MONROE ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563
Practice Address - Country:US
Practice Address - Phone:574-936-8004
Practice Address - Fax:574-936-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
R79905Medicare UPIN
IL753511Medicare ID - Type Unspecified