Provider Demographics
NPI:1124356696
Name:DR BRIAN RAGSDALE AND ASSOCIATES PC
Entity type:Organization
Organization Name:DR BRIAN RAGSDALE AND ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:RAGSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-551-9300
Mailing Address - Street 1:166 W WASHINGTON ST
Mailing Address - Street 2:SUITE, 730
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2311
Mailing Address - Country:US
Mailing Address - Phone:312-551-9300
Mailing Address - Fax:312-551-9313
Practice Address - Street 1:166 W WASHINGTON ST
Practice Address - Street 2:SUITE, 730
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2311
Practice Address - Country:US
Practice Address - Phone:312-551-9300
Practice Address - Fax:312-551-9313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-22
Last Update Date:2009-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL073000058103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty