Provider Demographics
NPI:1437515541
Name:PSYCYNERGY PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:PSYCYNERGY PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-566-4950
Mailing Address - Street 1:369 E SIBLEY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-2530
Mailing Address - Country:US
Mailing Address - Phone:708-566-4950
Mailing Address - Fax:708-566-4382
Practice Address - Street 1:369 E SIBLEY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-2530
Practice Address - Country:US
Practice Address - Phone:708-566-4950
Practice Address - Fax:708-566-4382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004026101Y00000X, 101YM0800X, 101YP2500X, 103T00000X, 103TF0000X, 320800000X
103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1403Medicaid
IL=========1OtherNPI