Provider Demographics
NPI:1356574024
Name:ELM PSYCHOLOGICAL SERVICE, INC.
Entity type:Organization
Organization Name:ELM PSYCHOLOGICAL SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINICIPLE
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCVEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:132-669-0025
Mailing Address - Street 1:233 E ERIE ST
Mailing Address - Street 2:#403
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2926
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:233 E ERIE ST
Practice Address - Street 2:ST. 403
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2926
Practice Address - Country:US
Practice Address - Phone:312-669-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007716103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty