Provider Demographics
NPI:1467897819
Name:CHRISTINA SAMYCIA PSYD, LTD.
Entity Type:Organization
Organization Name:CHRISTINA SAMYCIA PSYD, LTD.
Other - Org Name:MIND BODY HEALING, LTD.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOLOGIST/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMYCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-285-5287
Mailing Address - Street 1:77 W. WASHINGTON, STE 1704
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602
Mailing Address - Country:US
Mailing Address - Phone:312-285-5287
Mailing Address - Fax:
Practice Address - Street 1:77 W. WASHINGTON, STE 1704
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602
Practice Address - Country:US
Practice Address - Phone:312-285-5287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007818103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty