Provider Demographics
NPI:1184036121
Name:DC PSYCH CONSULTING
Entity Type:Organization
Organization Name:DC PSYCH CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CHILES
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:708-510-4755
Mailing Address - Street 1:3615 PARK DR
Mailing Address - Street 2:SUITE 203 B
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1186
Mailing Address - Country:US
Mailing Address - Phone:708-510-4755
Mailing Address - Fax:
Practice Address - Street 1:3615 PARK DR
Practice Address - Street 2:SUITE 203 B
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1186
Practice Address - Country:US
Practice Address - Phone:708-510-4755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007594103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL337564789100Medicaid