Provider Demographics
NPI:1245313071
Name:PSYCHOLOGY PROFESSIONALS
Entity type:Organization
Organization Name:PSYCHOLOGY PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:T
Authorized Official - Last Name:EBEID
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-268-4159
Mailing Address - Street 1:9010 RESERVE DR
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1183
Mailing Address - Country:US
Mailing Address - Phone:708-268-4159
Mailing Address - Fax:630-455-0553
Practice Address - Street 1:9010 RESERVE DR
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60480-1183
Practice Address - Country:US
Practice Address - Phone:708-268-4159
Practice Address - Fax:630-455-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007039103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty