Provider Demographics
NPI:1073835815
Name:CL PSYCHOTHERAPY SERVICES
Entity Type:Organization
Organization Name:CL PSYCHOTHERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:QUAY
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-372-3211
Mailing Address - Street 1:180 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7401
Mailing Address - Country:US
Mailing Address - Phone:312-372-3211
Mailing Address - Fax:312-372-4822
Practice Address - Street 1:180 N MICHIGAN AVE
Practice Address - Street 2:SUITE 2222
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7401
Practice Address - Country:US
Practice Address - Phone:312-372-3211
Practice Address - Fax:312-372-4822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-21
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-003380103TB0200X, 103TC0700X
IL149-0049291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty