Provider Demographics
NPI:1295024412
Name:ADVANCED PSYCHOLOGY LLC
Entity Type:Organization
Organization Name:ADVANCED PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMIKUN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-404-1384
Mailing Address - Street 1:4433 N SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-7308
Mailing Address - Country:US
Mailing Address - Phone:847-404-1384
Mailing Address - Fax:
Practice Address - Street 1:2530 CRAWFORD AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4970
Practice Address - Country:US
Practice Address - Phone:847-404-1384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008082103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty