Provider Demographics
NPI:1003008178
Name:PSYCHOLOGICAL HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:PSYCHOLOGICAL HEALTH ASSOCIATES
Other - Org Name:HEALTH AND WELLNESS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-587-3311
Mailing Address - Street 1:303 N 2ND ST STE B
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1804
Mailing Address - Country:US
Mailing Address - Phone:630-587-3311
Mailing Address - Fax:630-587-3355
Practice Address - Street 1:303 N 2ND ST STE B
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1804
Practice Address - Country:US
Practice Address - Phone:630-587-3311
Practice Address - Fax:630-587-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060007700071003068101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty