Provider Demographics
NPI:1033267661
Name:PRO PSYCH ASSOCIATES SC
Entity Type:Organization
Organization Name:PRO PSYCH ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OK
Authorized Official - Middle Name:RO
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-544-5102
Mailing Address - Street 1:2604 DEMPSTER ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8412
Mailing Address - Country:US
Mailing Address - Phone:847-544-5102
Mailing Address - Fax:847-544-5103
Practice Address - Street 1:2604 DEMPSTER ST
Practice Address - Street 2:SUITE 307
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-8412
Practice Address - Country:US
Practice Address - Phone:847-544-5102
Practice Address - Fax:847-544-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006314103TC0700X
IL071-006486103TC0700X
IL036-0739052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632426OtherBLUE CROSS
ILK53462Medicare PIN
IL209473Medicare PIN