Provider Demographics
NPI:1063461069
Name:CENTER FOR PERSONAL DEVELOPMENT
Entity Type:Organization
Organization Name:CENTER FOR PERSONAL DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:NAKISHER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-755-7000
Mailing Address - Street 1:444 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1820
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-755-7000
Mailing Address - Fax:312-755-7001
Practice Address - Street 1:444 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1820
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-755-7000
Practice Address - Fax:312-755-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005565103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21623432OtherBCBS
IL535920Medicare ID - Type Unspecified