Provider Demographics
NPI:1598470742
Name:PEETINC CLINICAL AND CONSULTING SERVICES PLLC
Entity Type:Organization
Organization Name:PEETINC CLINICAL AND CONSULTING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:COROLYN
Authorized Official - Last Name:PEET
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-785-2487
Mailing Address - Street 1:2220 S KEDVALE AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-2812
Mailing Address - Country:US
Mailing Address - Phone:312-785-2487
Mailing Address - Fax:
Practice Address - Street 1:2220 S KEDVALE AVE FL 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-2812
Practice Address - Country:US
Practice Address - Phone:312-785-2487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health