Provider Demographics
NPI:1043323744
Name:INSIGHT PSYCHOLOGICAL CENTER
Entity Type:Organization
Organization Name:INSIGHT PSYCHOLOGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:FOTI
Authorized Official - Last Name:MCCLANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-337-6064
Mailing Address - Street 1:333 N MICHIGAN AVE.
Mailing Address - Street 2:1900
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601
Mailing Address - Country:US
Mailing Address - Phone:312-540-9955
Mailing Address - Fax:312-540-0944
Practice Address - Street 1:333 N MICHIGAN AVE.
Practice Address - Street 2:1900
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601
Practice Address - Country:US
Practice Address - Phone:312-540-9955
Practice Address - Fax:312-540-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0091641512OtherBC/BS