Provider Demographics
NPI:1295100485
Name:PARKSIDE PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:PARKSIDE PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, ABPP
Authorized Official - Phone:847-420-5088
Mailing Address - Street 1:840 S WAUKEGAN RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2619
Mailing Address - Country:US
Mailing Address - Phone:847-420-5088
Mailing Address - Fax:
Practice Address - Street 1:840 S WAUKEGAN RD STE 203
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2619
Practice Address - Country:US
Practice Address - Phone:847-420-5088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007555103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty