Provider Demographics
NPI:1790960763
Name:SIGNATURE CONSULTING AND PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:SIGNATURE CONSULTING AND PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:NIEKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-377-1695
Mailing Address - Street 1:2210 DEAN ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1066
Mailing Address - Country:US
Mailing Address - Phone:630-377-1695
Mailing Address - Fax:630-584-2490
Practice Address - Street 1:2210 DEAN ST
Practice Address - Street 2:SUITE I
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1066
Practice Address - Country:US
Practice Address - Phone:630-377-1695
Practice Address - Fax:630-584-2490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4532249OtherBCBS PROVIDER