Provider Demographics
NPI:1477321164
Name:CRITCHELL PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:CRITCHELL PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-669-8616
Mailing Address - Street 1:636 CHURCH ST STE 508
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4581
Mailing Address - Country:US
Mailing Address - Phone:773-669-8616
Mailing Address - Fax:
Practice Address - Street 1:636 CHURCH ST STE 508
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4581
Practice Address - Country:US
Practice Address - Phone:773-669-8616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1629517024OtherBCBS
1629517024OtherUNITED