Provider Demographics
NPI:1942759881
Name:PSYCHSYNERGY BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:PSYCHSYNERGY BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/ OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-232-3724
Mailing Address - Street 1:527 S CUYLER AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:527 S CUYLER AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1502
Practice Address - Country:US
Practice Address - Phone:708-232-3724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071000008646251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health