Provider Demographics
NPI:1619169505
Name:TOLLEY, PHYLLIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:
Last Name:TOLLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:PHYLLIS
Other - Middle Name:S
Other - Last Name:TOLLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1359 NEWCASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154
Mailing Address - Country:US
Mailing Address - Phone:708-890-8332
Mailing Address - Fax:
Practice Address - Street 1:340 BUTTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:708-743-5914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-007067103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071-007067OtherSTATE LICENSE NUMBER