Provider Demographics
NPI:1104941798
Name:PSYCHOLOGICAL WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:PSYCHOLOGICAL WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:SZUMIGALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-369-2640
Mailing Address - Street 1:12632 ROYAL GORGE CT
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1661
Mailing Address - Country:US
Mailing Address - Phone:708-369-2640
Mailing Address - Fax:708-995-5058
Practice Address - Street 1:1030 S LA GRANGE RD
Practice Address - Street 2:SUITE 8
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2800
Practice Address - Country:US
Practice Address - Phone:708-352-2597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)