Provider Demographics
NPI:1093088676
Name:JAL PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:JAL PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-364-7046
Mailing Address - Street 1:60 ORLAND SQUARE DR STE 203
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-6523
Mailing Address - Country:US
Mailing Address - Phone:708-364-7046
Mailing Address - Fax:708-364-7048
Practice Address - Street 1:60 ORLAND SQUARE DR STE 203
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-6523
Practice Address - Country:US
Practice Address - Phone:708-364-7046
Practice Address - Fax:708-364-7048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006856261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health