Provider Demographics
NPI:1376173831
Name:DR. JAMIE RILEY, PSYCHOTHERAPY PRACTICE, LLC
Entity type:Organization
Organization Name:DR. JAMIE RILEY, PSYCHOTHERAPY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-601-1205
Mailing Address - Street 1:2015 S ARLINGTON HEIGHTS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4150
Mailing Address - Country:US
Mailing Address - Phone:708-601-1205
Mailing Address - Fax:
Practice Address - Street 1:2015 S ARLINGTON HEIGHTS RD STE 110
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4150
Practice Address - Country:US
Practice Address - Phone:708-601-1205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty