Provider Demographics
NPI:1730468307
Name:PSYCHIATRY SPECIALISTS P.C.
Entity Type:Organization
Organization Name:PSYCHIATRY SPECIALISTS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-605-4986
Mailing Address - Street 1:4535 N BEACON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5518
Mailing Address - Country:US
Mailing Address - Phone:773-629-0716
Mailing Address - Fax:
Practice Address - Street 1:4535 N BEACON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5518
Practice Address - Country:US
Practice Address - Phone:773-629-0716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1700042454OtherNPI 1700042454