Provider Demographics
NPI:1386604577
Name:CENTER FOR PSYCHOLOGICAL SERVICES - OAK LAWN LTD
Entity type:Organization
Organization Name:CENTER FOR PSYCHOLOGICAL SERVICES - OAK LAWN LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND HEAD OF THE PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:KOWALSKY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-424-0001
Mailing Address - Street 1:10735 S CICERO AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-5400
Mailing Address - Country:US
Mailing Address - Phone:708-424-0001
Mailing Address - Fax:708-424-1394
Practice Address - Street 1:10735 S CICERO AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5400
Practice Address - Country:US
Practice Address - Phone:708-424-0001
Practice Address - Fax:708-424-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071 003598261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623005OtherBCBS PROVIDER NUMBER
IL01623005OtherBCBS PROVIDER NUMBER