Provider Demographics
NPI:1891065561
Name:VICTORIA REID PHD LTD
Entity Type:Organization
Organization Name:VICTORIA REID PHD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-478-2372
Mailing Address - Street 1:15020 S RAVINIA AVE STE 23
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-5352
Mailing Address - Country:US
Mailing Address - Phone:708-478-2372
Mailing Address - Fax:708-586-6461
Practice Address - Street 1:15255 S 94TH AVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3800
Practice Address - Country:US
Practice Address - Phone:708-479-6522
Practice Address - Fax:708-586-6461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005245103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6973Medicare PIN
ILIL6974Medicare PIN