Provider Demographics
NPI:1497149322
Name:AG PSYCHOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:AG PSYCHOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUINTA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-888-2602
Mailing Address - Street 1:4365 LAWN AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1465
Mailing Address - Country:US
Mailing Address - Phone:773-888-2602
Mailing Address - Fax:
Practice Address - Street 1:4365 LAWN AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1465
Practice Address - Country:US
Practice Address - Phone:773-888-2602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-28
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009054103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1093906349OtherCLINICAL PSYCHOLOGIST