Provider Demographics
NPI:1215349832
Name:PEACE OF MIND PYSCHOLOGICAL CLINIC
Entity type:Organization
Organization Name:PEACE OF MIND PYSCHOLOGICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ZAKIYYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-712-9574
Mailing Address - Street 1:1020 PARK DR UNIT 738
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2529
Mailing Address - Country:US
Mailing Address - Phone:773-712-9574
Mailing Address - Fax:
Practice Address - Street 1:1818 RIDGE RD STE 1M
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1762
Practice Address - Country:US
Practice Address - Phone:773-712-9574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty