Provider Demographics
NPI:1619004363
Name:ADVANCED PSYCH CARE LLC
Entity Type:Organization
Organization Name:ADVANCED PSYCH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JON
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-222-0793
Mailing Address - Street 1:3233 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 301 B
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1557
Mailing Address - Country:US
Mailing Address - Phone:847-222-0793
Mailing Address - Fax:847-222-9769
Practice Address - Street 1:3233 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 301 B
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1557
Practice Address - Country:US
Practice Address - Phone:847-222-0793
Practice Address - Fax:847-222-9769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004102103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213503Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER