Provider Demographics
NPI:1093265043
Name:PSYCHWISE SERVICES LLC
Entity Type:Organization
Organization Name:PSYCHWISE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-826-7702
Mailing Address - Street 1:1305 CROMWELL CT
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1214
Mailing Address - Country:US
Mailing Address - Phone:847-826-7702
Mailing Address - Fax:888-393-7595
Practice Address - Street 1:34121 N US HIGHWAY 45 STE 222
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1774
Practice Address - Country:US
Practice Address - Phone:847-826-7702
Practice Address - Fax:888-393-7595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490042681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty