Provider Demographics
NPI:1013152610
Name:ART OF PSYCHOLOGY, INC.
Entity Type:Organization
Organization Name:ART OF PSYCHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNISH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-528-0619
Mailing Address - Street 1:948 ENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5987
Mailing Address - Country:US
Mailing Address - Phone:847-528-0619
Mailing Address - Fax:
Practice Address - Street 1:948 ENFIELD DR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5987
Practice Address - Country:US
Practice Address - Phone:847-528-0619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-007187103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK36934Medicare PIN