Provider Demographics
NPI:1841798642
Name:DYNAMIC PSYCHOLOGICAL SERVICES, LTD.
Entity Type:Organization
Organization Name:DYNAMIC PSYCHOLOGICAL SERVICES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-620-0403
Mailing Address - Street 1:645 N MICHIGAN AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2881
Mailing Address - Country:US
Mailing Address - Phone:312-620-0403
Mailing Address - Fax:
Practice Address - Street 1:645 N MICHIGAN AVE STE 500
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2881
Practice Address - Country:US
Practice Address - Phone:312-620-0403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009652103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty