Provider Demographics
NPI:1316466857
Name:ETHOS PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:ETHOS PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ELIOT
Authorized Official - Last Name:LEFFEL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:917-403-4631
Mailing Address - Street 1:7903 LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3537
Mailing Address - Country:US
Mailing Address - Phone:917-403-4631
Mailing Address - Fax:
Practice Address - Street 1:444 N NORTHWEST HWY STE 375
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3271
Practice Address - Country:US
Practice Address - Phone:917-403-4631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008161103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty