Provider Demographics
NPI:1699120600
Name:PC PSYCHOTHERAPY
Entity type:Organization
Organization Name:PC PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCP
Authorized Official - Phone:630-292-0029
Mailing Address - Street 1:50 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5484
Mailing Address - Country:US
Mailing Address - Phone:630-292-0029
Mailing Address - Fax:
Practice Address - Street 1:50 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5484
Practice Address - Country:US
Practice Address - Phone:630-292-0029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009701101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty