Provider Demographics
NPI:1578994489
Name:ICONPSYCHOLOGIES
Entity Type:Organization
Organization Name:ICONPSYCHOLOGIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SOBEREKON
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:KOKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-933-9300
Mailing Address - Street 1:1750 E 87TH ST
Mailing Address - Street 2:SUIT 109
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-2713
Mailing Address - Country:US
Mailing Address - Phone:773-933-9300
Mailing Address - Fax:773-933-9302
Practice Address - Street 1:8961 ENCLAVE DR
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-8394
Practice Address - Country:US
Practice Address - Phone:312-342-6066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCTORS UNLIMITED SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.117531101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty