Provider Demographics
NPI:1972188241
Name:HUMANISTIC PSYCHOLOGISTS OF CHICAGO, INC.
Entity Type:Organization
Organization Name:HUMANISTIC PSYCHOLOGISTS OF CHICAGO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JUNE-SCHAPELER
Authorized Official - Last Name:BERGEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-512-4656
Mailing Address - Street 1:1945 W WILSON AVE STE 6113
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5259
Mailing Address - Country:US
Mailing Address - Phone:773-512-4656
Mailing Address - Fax:
Practice Address - Street 1:1945 W WILSON AVE STE 6113
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5259
Practice Address - Country:US
Practice Address - Phone:773-512-4656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071007367OtherLICENSED CLINICAL PSYCHOLOGIST