Provider Demographics
NPI:1760680789
Name:COMPREHENSIVE PSYCHOLOGICAL RESOURCE
Entity Type:Organization
Organization Name:COMPREHENSIVE PSYCHOLOGICAL RESOURCE
Other - Org Name:SUZETTE RUSH-DRAKE, PSY.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSH DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:PSY'D
Authorized Official - Phone:847-390-0776
Mailing Address - Street 1:241 GOLF MILL CTR STE 602
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1215
Mailing Address - Country:US
Mailing Address - Phone:847-390-0776
Mailing Address - Fax:847-390-7625
Practice Address - Street 1:241 GOLF MILL CTR STE 602
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1215
Practice Address - Country:US
Practice Address - Phone:847-390-0776
Practice Address - Fax:847-390-7625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071 004832103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty