Provider Demographics
NPI:1912031659
Name:WEST SUBURBAN PSYCHOLOGICAL SERVICES, LTD.
Entity Type:Organization
Organization Name:WEST SUBURBAN PSYCHOLOGICAL SERVICES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REST
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-585-0039
Mailing Address - Street 1:1809 NORTH MILL STREET
Mailing Address - Street 2:SUITE G
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563
Mailing Address - Country:US
Mailing Address - Phone:630-585-0039
Mailing Address - Fax:630-585-1491
Practice Address - Street 1:1809 NORTH MILL STREET
Practice Address - Street 2:SUITE G
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:630-585-0039
Practice Address - Fax:630-585-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04522270OtherBCBS
IL200684Medicare PIN