Provider Demographics
NPI:1003172404
Name:PSYCHIATRY SPECIALISTS
Entity Type:Organization
Organization Name:PSYCHIATRY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RATCLIFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-239-9600
Mailing Address - Street 1:4535 N BEACON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5518
Mailing Address - Country:US
Mailing Address - Phone:773-239-9600
Mailing Address - Fax:
Practice Address - Street 1:855 W 103RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2357
Practice Address - Country:US
Practice Address - Phone:773-239-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121844251S00000X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036121844Medicaid