Provider Demographics
NPI:1194827238
Name:ASSOCIATES IN CLINICAL PSYCHOLOGY & SUBSTANCE ABUSE PC
Entity Type:Organization
Organization Name:ASSOCIATES IN CLINICAL PSYCHOLOGY & SUBSTANCE ABUSE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:708-957-3695
Mailing Address - Street 1:2024 HICKORY RD STE 103
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2158
Mailing Address - Country:US
Mailing Address - Phone:708-957-3662
Mailing Address - Fax:708-957-3695
Practice Address - Street 1:2024 HICKORY RD STE 103
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2158
Practice Address - Country:US
Practice Address - Phone:708-957-3662
Practice Address - Fax:708-957-3695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1673080OtherBCBS GROUP PROVIDER NUMBE
IL333110Medicare ID - Type Unspecified